Risk Adjustment
Risk Adjustment
Achieve financial success in value-based care with Vertex Medical Billing’s comprehensive risk adjustment and consulting solutions.
As a Leading Provider of End-to-End Risk Adjustment Services, Our Offerings include:
- Real-time risk DNA insights
- Access to our team of risk adjustment physicians
- Dedicated and experienced risk adjustment account managers
- Access to our robust list of comprehensive health management tools
- Prospective, concurrent, and retrospective HCC clinical-coding experts
- Transformational data-based intelligence
- Complete risk and quality performance reporting insights
Prospective Risk Review
As health plans and provider networks transition to value-based contracts, precise risk documentation becomes vital to securing proper reimbursement. Gaining meaningful insights into patient-provider interactions before the date of service is essential to ensuring accuracy and optimizing payment outcomes. We focus on identifying and assessing opportunities for capturing complete and accurate diagnoses to ensure comprehensive patient records and optimized risk adjustment. Our services include complete EMR integration, enabling seamless data flow and interoperability across systems. We utilize NLP scrubbing to clean and refine text within Natural Language Processing tools, enhancing data accuracy. By improving documentation specificity, we help enable precise risk scoring. Additionally, we offer provider education to promote best practices in clinical documentation and coding. Our expertise also extends to diagnostic inference from ancillary documentation, ensuring that all relevant patient information is accurately captured and utilized.
Concurrent Risk Review
Concurrent reviews are conducted within the EHR system to capture risk-adjusting ICD (HCC) codes in real time. However, many EHR systems are not built to fully support the HCC model. To bridge this gap, leading medical groups and payer organizations rely on Vertex Medical Billing’s expert claims review and HCC coding services to ensure claims are optimized before submission. We specialize in accurate HCC capture to ensure proper risk adjustment and reimbursement, focusing on thorough and precise documentation of patient conditions. Our services also include comprehensive HEDIS reviews, aimed at improving healthcare quality measures and ensuring compliance with regulatory standards. We facilitate clear and efficient provider queries to resolve documentation gaps and clarify diagnoses. Additionally, we offer detailed missed opportunity reporting to highlight areas where potential diagnoses or quality measures may have been overlooked, enabling continuous improvement and optimized performance.
Retrospective Risk Review
Gain deeper insights into healthcare beneficiary risk stratification with Vertex Medical Billing’s technology-driven risk adjustment solutions. Our retrospective chart reviews thoroughly analyze dates of service to capture HCC codes with the highest level of specificity. Through our HCC optimization platform, we identify care gaps and missed coding opportunities during the retrospective review process—helping you enhance accuracy, close care gaps, and improve operational efficiency. We provide end-to-end support for HCC capture, ensuring accurate documentation and coding to optimize risk adjustment and reimbursement. Our services include dual abstraction for enhanced accuracy, along with NLP scrubbing to clean and refine clinical data for precise coding. We manage HCC adds, edits, and deletions to maintain up-to-date records and ensure compliance. Our team ensures precise RAPS/EDS submissions, facilitating optimal and accurate reimbursements. Additionally, we conduct thorough HEDIS reviews to support quality reporting and compliance. Our efficient chart retrieval services further streamline the data collection process, ensuring timely and complete access to patient records.
Risk Adjustment Optimization
Vertex Medical Billing’s Risk Adjustment Optimization platform leverages top-tier plan data to analyze documentation, EHRs, HCC workflows, and patient acuity—streamlining your risk adjustment processes while ensuring accurate capture of each patient’s true severity of illness. Our NLP-powered system provides complete visibility into your risk profile, supporting payer-provider contract negotiations, uncovering missed revenue opportunities, and improving patient care. Reach out to us for a comprehensive Risk DNA Analysis and let Vertex Medical Billing help you navigate today’s ever-evolving healthcare landscape.