Risk Score Management

Ready to earn the 7.36% incentive?

Optimize revenue with risk adjustment factor (RAF) scores that reflect patient population(s).

Risk adjustment is becoming a standard feature of quality and utilization-based programs under CMS and increasingly by commercial payers. Organizations benefit significantly from ongoing audits and educational programs oriented towards accurate HCC coding. Common provider documentation and coding errors that artificially reduce RAF scores, including diagnoses that lack specificity, missing diagnoses, and diagnoses that lack supporting documentation, can be addressed with our solutions.

Benefits

  • Identify patterns where ICD-10-CM codes with HCC relevance are submitted on claims, but lack adequate supporting documentation.
  • Prepare for a Risk Adjustment Data Validation ( RADV) audit for Medicare Advantage Programs or a MIPS Cost audit.
  • Locate opportunities to lower cost of care and increase the MIPS Cost performance score.

The Healthmonix Approach

Data Integration

Exchange healthcare data with ease by tapping into our integration network.

Gaps in Care

Address and identify gaps in care with our customizable reports. Then, dig down into disease states, provider subgroups and patient cohorts.

Risk Score Management

Optimize Risk Adjustment Factor (RAF) scores with accurate HCC data to improve MIPS scores and Medicare Advantage reimbursements. 

MIPS & APM Consulting

Expert assistance to maximize your return on investment for QPP participation.

QCDRS & SPECIALTY MEASURES

Conduct  MIPS reporting with Healthmonix measures approved by CMS that pertain to your organization's specialty.

CHRONIC CARE MANAGEMENT

Close gaps in care (and  MIPS performance) with a fully managed care coordination program for your patients.