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Risk adjustment

Learn how to ensure appropriate compensation for taking on high risk patients. Get tips and tricks on achieving fast turnaround times in risk adjustment.

Risk Adjustment FAQs

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Health plans
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Hierarchical Condition Category (HCC) coding is a risk-adjustment model designed to estimate future healthcare costs for patients.

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Hierarchical Condition Category (HCC) Coding: Purpose & Use

Health plans
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Examine how the new Making Care Primary model from CMS aims to integrate primary care, clinical and SDoH data to transform healthcare.

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Making Care Primary Model Integrates Primary Care, Clinical and SDoH Data to Transform Healthcare

Health plans
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See why plans need to solve for risk adjustment blind spots using a member-focused retrieval of information.

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Modern Day Risk Adjustment Reimbursement

Health plans
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Chase lists produced with old methods don't deliver the best outcomes, are inefficient, error prone and results in provider abrasion. See the alternative.

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Traditional Chase Lists vs Modern Chase Intelligence

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An HCC is a category of chronic medical conditions that share similar cost patterns. Learn more. Read more HCC FAQs here.

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HCC Coding FAQs

Health plans
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Risk adjustment is used to appropriately compensate health plans for the costs associated with taking on members with chronic health conditions. See more.

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Risk Adjustment FAQs

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MAOs have six additional months to ensure a complete and accurate data submission. See how to optimize your additional PY2020 Reconciliation Run.

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How to Optimize Additional PY 2020 Reconciliation Run

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NLP enhances healthcare risk adjustment coding. Payers validate unmatched codes efficiently, boosting accuracy. Implement an NLP-enabled Second Level Review.

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How Payers Can Use NLP to Improve Risk Adjustment Coding

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Real-world dataHIPAA PrivacyElectronic health recordsClinical researchRevenue cycle managementMedical codingRisk adjustment

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