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Risk Adjustment

Risk Adjustment.   It can be defined as “A corrective tool used to level the playing field by adjusting for the differences in risk among specific patients.”  At ATTAC Consulting Group (ACG), we define it as “A complex program directly impacting your bottom line, demanding attention to many elements, and requiring significant focus and expertise to implement effectively.”

For Medicare Advantage plans seeking to assure that their risk adjustment submissions are complete and accurate, and commercial Plans participating in the ACA triple “R’s” (Risk Adjustment, Reinsurance and Risk Corridors) of the Affordable Care Act – risk adjustment plays a critical role in a Plan’s financial performance.

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:

  • ACA Risk Adjustment Initial Validation Auditing (IVA)

  • Claims data review and analysis to validate filter accuracy, HCC coding gaps and opportunities

  • Processes and protocol development to ensure compliant diagnosis capture and reporting

  • Provider HCC and chart coding audits and education programs

  • RA Quality Assurance Program design

  • Edge Server data reporting process flows and error / discrepancy support

  • Medicare RADV style HCC reviews and RADV Audit Support

  • Home assessment vendor coding and compliance review

  •  Investigation Support and Expert Testimony

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301 E. Liberty Street, Suite 605
Ann Arbor, MI 48104
T. (734) 214-2990