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Download the eBook to learn why prospective review is critical in today’s increasingly competitive market:
Visit our resources library to download the next eBook in the 360° Risk Adjustment series. The framework is divided into 8 core components:
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Each piece is critical to overall success. Within each corresponding eBook, you'll find our strategic insights for transforming operations and detailed explanations on how to drive performance improvements. |
Healthcare providers typically generate claims to be reimbursed for services provided. Information on medical claims, however, can be an incomplete account of patients’ health – providers are paid primarily based on procedure codes and not diagnosis codes. In order for an organization’s risk score to truly reflect the level of patient acuity, patient diagnoses must be accurately documented and coded.
Prospective risk adjustment refers to the effort of proactively identifying gaps in HCC capture and accurately documenting and coding for these risk conditions at the point of care. Many organizations – especially in the Medicare Advantage space – have experience deploying health risk assessments, conducting in-home assessments, and scheduling annual wellness visits to ensure accurate identification of risk conditions.
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