Risk Adjustment
Solutions
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.
- Chart Retrieval
- Retrospective Coding Review
- Prospective Data Mining
- By reviewing medical records by certified risk adjustment coders, you can discover documentation improvement opportunities that will not appear in claims analytics. You can also tailor provider education based upon data from providers own charts
- Physician Engagement to improve documentation
- Group sessions
- One on One training
- Access to online provider training portal (In development)
- ROI on approved RAF
- Executive summaries
- RAF Improvement Program Design/Implementation
- Fully-managed solutions – Importing all essential health plan data and processing the outcomes using all major risk models
- Spot non-optimized members owing to planned RAF scores or suspected morbidities
- Intervention Targeting – spot chase logic methodologies to prioritize medical record retrieval based on claims and/or pharmacy data, demographics and self-reported conditions
- Periodic reporting and data transparency – Track the coding progress and revenue optimization in real-time
- Member and provider engagement – Identify service and documentation gaps from coding solutions while offering intervention solutions customized to every client’s goals
- 360 Medical record retrieval, medical record and inferred coding services
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
- Fully-managed and flexible solutions – Importing all key health plan data and processing the results through all major risk models
- Identify non-optimized members due to projected RAF scores or suspected morbidities
- Intervention Targeting – Identify chase logic methodologies to prioritize medical record retrieval based on claims and/or pharmacy data, demographics and self-reported conditions
- Agile reporting and data transparency – Monitor the progress of coding assignments and revenue optimization activities in real-time
- Member and provider engagement – Identify service gaps and documentation gaps from coding services while providing intervention solutions tailored to each client’s goals
- 360 Medical record retrieval, medical record coding and inferred coding services
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
- On-site & Off-site Medical Record Scanning
- Digital Local and Remote Electronic Medical Records
- EHR / Portal Acquired Medical Records
- Fax Medical Records
- Data mining from legacy systems.
Reports with Actionable steps
We at Guhilot generate customized reports, these reports can be further grilled down to take actionable steps for
- Provider specific analytics
- Category specific analytics
- Health-plan Specific analytics
- Identify Potential flaws in documentation where a specific Dx is not supported or could be supported with need for additional documentation
How You Benefit
Identifying risk adjustment opportunities that impact revenueWe 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
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 chartsWe 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.
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.
Member outreach programsWe have very effective member outreach program that targets the highest potential revenue opportunities.
Effectively DocumentationWe ensure that documentation supports 100% of the codes extracted and reported to ensure you are covered for audit that may arise.
