Optimize Risk Adjustment (HCC)

Optimize Risk Adjustment (HCC)

Maximize Government Reimbursement, Optimize Risk Adjustment

Health plans managing high-risk, complex populations, including government beneficiaries, often lack access to important data that would help optimize risk adjustment scores under CMS’s Hierarchical Condition Categories (HCC) and other value-based initiatives.

These complex coding and payment models make it challenging to reach the ratings needed to qualify for federal funds. To minimize financial risk, health plans managing complex government populations need to:

  • Understand CMS codes and requirements, effectively track and trend HCC status, and create actionable reports
  • Actively manage their government beneficiaries with uniquely high rates of chronic conditions, cognitive impairments and functional limitations—and use the resulting data and insight to maximize reimbursement
  • Stay current with coding and reporting requirements and changing regulations
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Visibility + intelligence = risk-based reimbursement opportunity

Health plans need to identify, manage and report on HCC-related opportunities. They need a care management program that can:

  • Gain data-driven visibility and intelligence to improve scores and maximize reimbursement revenue
  • Improve documentation, address gaps in care and medication challenges, and drive better satisfaction to improve Medicare Star Ratings and other rating initiatives
  • Monitor and accurately report on the health of government populations for optimal HCC scoring

Developing a care management strategy with Medecision can help you spot and destroy hazards on the road to managing risk.

MEDECISION’S ADVISORY SERVICES TEAM OFFERS EXPLORATORY ASSESSMENTS TO HELP YOU IDENTIFY OPTIONS AND STRATEGIES TO ACHIEVE CLINICAL AND FINANCIAL SUCCESS.

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