RISK ADJUSTMENT
Complete and accurate capture of all diagnosis codes from sources across the continuum of care, delivered directly to your EHR
MULTI-SOURCED risk adjustment intellIgence
Your organization's internal data is undoubtedly valuable but a risk adjustment strategy that relies primarily on the data in your current EHR system significantly limits potential for success in a value-based care environment.
Even the most sophisticated HCC coding and risk adjustment tools analyze only the data already captured by the healthcare organization themselves and are therefore delivering a fraction of the total potential value.
MDPORTALS risk adjustment SOLUTION
Once the captured data from across the continuum of care has been synthesized, the unified composite health record is scanned for HCC opportunities.
MDPortals uses proven Ai algorithms to identify and extract all HCC related ICD-10 codes for new capture and recapture from the full scope of data for the most comprehensive RAF score possible.
unified analysis
The resulting insights are compared against your existing codes for a truly unified analysis.
New HCC opportunities are clearly distinguished from previously known diagnosis codes in a single view.
New HCC opportunities are linked directly to the underlying documentation that supports the suspected diagnosis.
Known diagnosis codes are linked directly to the underlying documentation that validates existing diagnosis.
Opportunities where increased specificity of known diagnosis codes will impact RAF scores are indicated where applicable.
Probable HCC opportunities based on predictive analytics and machine learning are included where appropriate. MDPortals proprietary algorithm detects the statistical probability of additional diagnoses based on a comparison to patients with similar backgrounds and conditions.
Our technology ensures that manifestations and complications are included where appropriate. This more complete picture of patient complexity is particularly crucial when treating chronic conditions, and has a significant impact on RAF scores.
The risk adjustment summary makes it easy to verify that codes are applied correctly with one click access to each inference in the source documentation.
Our solution protects against overcoding by deleting and removing diagnosis codes within claims data that have no clinical justification nor supporting underlying documentation.
Optimize Risk-Adjusted Revenue
Ensure risk-adjusted payments and incentives for Medicare Advantage patients are complete and accurate by capturing all appropriate diagnosis codes.
Increase RAF scores through more accurate and complete HCC coding.
Identify new risk adjustment-eligible diagnoses that would otherwise be missed due to incomplete documentation.
Refine known diagnoses by ensuring complexity is coded for optimal RAF score accuracy.
Validate known diagnosis codes with documentation from external sources.
Leverage supporting documentation from everywhere your patients received care, all in one view within your EHR.
Streamline Clinical and Administrative Workflows
The compendium was designed to fit into any stage of your workflow. The risk adjustment summary can be used to enhance prospective and pre-encounter preparation, point-of care evaluation and retrospective review.
Proactively address gaps in coding, clinical documentation, and patient care by preparing doctors to address all relevant conditions during encounters.
Easy reference at the point-of-care - physicians can reference the HCC Summary and underlying records all in one view, within their EHR.
Provide analysts with one clean and comprehensive package with direct links to supporting evidence - eliminating the need to hunt through unstructured and incomplete supporting documentation.
Prioritize members who need to be seen and direct intervention initiatives based on a more complete risk assessment.
Make it easier for providers and risk adjustment professionals to work together to ensure quality and thorough documentation of patient conditions.
Decrease encounters requiring coder review through prospective RAF scoring.
