Risk Adjustment

Improve risk capture, ensure accurate & compliant risk scores, and achieve accurate revenue

A comprehensive risk adjustment strategy not only ensures accurate revenue capture, but it also supports your organization’s mission to provide quality care at an affordable cost. Designing integrated risk adjustment programs and processes spans multiple functional areas within health plans, provider groups, ACOs, and other healthcare delivery models. GHG continues to anticipate the regulatory changes impacting risk adjustment.

Together with our sister company Pareto Intelligence, we work with our clients to proactively address shifts in payment models and build cross-functional teams to achieve maximum performance outcomes.

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Risk Documentation Improvement

A successful risk documentation program involves the proactive integration of several functional areas within an organization. GHG will work with you to identify potential areas for documentation improvement and develop a step-by-step implementation plan that will improve revenue capture, enhance the quality of submissions to CMS, and mitigate compliance risk.

Root Cause Analysis

Once the prevalence of data quality issues have been identified, it’s imperative that plans take the evaluation a step further and determine the root cause of these issues. GHG will work with your organizations’ applicable resources, ranging from vendors and partners to IT and business personnel, in order to identify issues at the source, implement a remediation plan, and prevent recurrence.

Provider Education

A major key to achieving long-term risk documentation improvement is ongoing provider education. To forge the long-term behavioral changes needed to improve the completeness, accuracy, and compliance of diagnosis risk capture at the point of care, GHG develops coaching programs that are backed by analytics and lead to patient panel-specific and performance-based educational programs.

Prospective Risk Capture

Prospective risk capture programs demand that plans continually evaluate performance of the providers in the network to inform their strategic and operational path forward. This requires a detailed level of analysis beyond simply calculating chronic condition recapture rates. GHG is poised to help incorporate a prospective risk documentation program into your broader clinical and quality strategy.

RAPS/EDS Reconciliation and Gap Analysis

The key to being successful in the transition EDS is knowing your data. To avoid the risk of compliance exposure, GHG not only looks for incremental revenue, but we also take a bi-directional look at the data to ensure it is both complete and accurate. A RAPS/EDS revenue audit or EDS gap analysis enables our experts to identify top errors and help you prioritize remediation efforts.

Mock RADV Audit

RADV preparedness is critical in ensuring that all business units know their role and can execute effectively if your plan is selected for audit. GHG will work with your team to replicate the entire RADV process, starting with the analytics required to identify the source of the HCC to creating the provider chase file and requesting the medical records for validation of the HCC.

Interim Management

If you are looking for a seasoned veteran, GHG can enrich your team with our own, providing the leadership and knowledge your organization needs. GHG’s sales and marketing experts can supplement your existing team with able professionals who have years of experience providing strategic services to the industry.

HCC Program Compliance

A comprehensive HCC audit program is an essential part of any risk adjustment strategy in order to mitigate risk with CMS. GHG’s risk adjustment veterans can help you round out your entire HCC compliance program preparedness by conducting targeted diagnosis audits, provider outlier audits, vendor over-reads, and mock RADV audits.

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