Risk Adjustment


Medical Risk Adjustment Solution

The shift from fee-for-service to value-based care is ushering in a new reality—and new complexities—for payers and providers. Health care organizations participating in value-based payment models are quickly learning that accurate and complete risk adjustment coding is critical, as it impacts everything from risk-adjusted revenue and overall financial performance to quality reporting, care planning and delivery Guhilot Health provides comprehensive risk adjustment solutions for health plans, managed care organizations and other risk-bearing entities.

We provide ongoing insights to understand the drivers of medical and financial risk with the ability to take action and grow revenue through a combination of services such as medical record retrieval, medical record coding by certified coders, identification of documentation of service gaps and both member -provider engagement services that close those gaps. The revenue optimization process involves risk analysis, which calculates historic and potential risk scores that determines suspected morbidities leading to both revenue optimization and cost containment opportunities.

Our Risk Adjustment Service Offers

We provide end to end risk adjustment solutions for health plans, managed care organizations and risk-bearing entities. Our services offer a 360 degree process including but not limited to the services mentioned below.

How We Do It

We realize your project and plan is unique in both scope and needs. Guhilot Health’s medical record retrieval service provides solutions for any retrieval project. Rather than offering our clients a “one-size-fits-all” approach, we work with health plans and medical groups to understand their project requirements thus finding opportunities for faster retrieval, cost reduction and minimizing provider abrasion.

How we Provide solution

Medical Record Retrieval

We manage the entire record collection process from fax notification and follow-up calls to collecting and indexing records for review. Once collected, all records are made available on our secure web portal that provides powerful search and review functionality to our clients. Supported MRR Methods

Reports with Actionable steps

We at Guhilot generate customized reports, these reports can be further grilled down to take actionable steps for

How You Benefit

Identifying risk Identifying risk adjustment opportunities that impact revenue

We have found an increase in RAF scores by close of 40%. Identify members with the highest-value undocumented medical conditions through our comprehensive 360 degree analysis then validate and substantiate medical conditions for clinical assessments with providers.

Maintaining good provider relationships Maintaining good provider relationships

Reduce provider abrasion through active feedback on opportunities for improvement in coding and documentation. We also assist in providers with member outreach programs.

Twice a year analysis of charts Twice a year analysis of charts

We analyse your charts twice a year for the price on one. We collate data from various sources to provide a comprehensive view of the data submission to ensure you do not miss any opportunity.

Guhilot risk adjustment solutions Effectively managing systems Effectively managing multiple systems

Access records efficiently from multiple sources and systems, minimizing provider abrasion. Our teams have experience working with leading industry electronic medical record(EMR) systems.

risk adjustment solutions Member outreach programs Member outreach programs

We have very effective member outreach program that targets the highest potential revenue opportunities.

Guhilot risk adjustment solutions Effectively Documentation Effectively Documentation

We ensure that documentation supports 100% of the codes extracted and reported to ensure you are covered for audit that may arise.

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