Accurate, Complete and Compliant Risk Score Capture and Reporting – Not as easy as it sounds.

ACG’s Risk Adjustment (RA) experts provide critical support for plans, provider organizations and vendors managing risk adjustment for Medicare Advantage, Commercial ACA, Medicaid and ACO enrollees.

Risk Adjustment significantly impacts your bottom line.  Assuring in that you are fully and accurately capturing and reporting each member or patient’s illness burden each year is critical to financial success.  Applying critical controls to monitoring coding, vendors and data submissions is essential to assure compliance and avoid false claims risk.   ACG’s RA experts help you implement effective RA programs.

Successful risk adjustment requires much more than just a chart review, and ACG’s team provides a comprehensive range of risk adjustment consulting, advisory and auditing services including:

  • HHS-RADV Initial Validation Auditing (IVA)

  • Claims and RA Data Tracing and Data Leakage Review

  • Prospective RA Capture Program Implementation and Oversight

  • Chart Coding Over-Read Audits

  • Provider Education Programs

  • Risk Adjustment Compliance Program and Controls

  • RA Vendor Oversight Programs

  • Medicare  RADV Audit Support

  • Home assessment vendor coding and compliance review

  •  Investigation Support and Expert Testimony