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Risk Adjustment Prospective and Retrospective Gap Identification

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Risk Adjustment Prospective and Retrospective Gap Identification

Sophisticated analysis leverages the power of your existing data.

Use the power of your data to improve risk score accuracy, provide clinical insights and reduce audit risk. Our proprietary data-driven algorithms use health plan and medical record data to identify potential medical conditions unreported during a current measurement year.

We can identify historical conditions using CMS RAPS return and other data and, through medical, pharmacy and DME claims data analysis as well as lab values, help identify suspect medical conditions not yet reported.

Prospective and Retrospective Gap Identification

Our data analytics help identify gaps in documentation and care by targeting historical and suspect medical conditions not reported during the current year. This analysis provides critical insight and allows providers to close gaps in member evaluation, care and documentation of conditions.

Retrospective Chart Chase List Creation

Once a medical condition is identified, additional logic is applied to determine medical records with the highest probability of having the condition documented. Targeting the most probably medical records will lower your overall risk adjustment administrative expenses and improve your ROI.

Benefits:

  • Improved member risk scores
  • Consistent CMS compliance
  • Boosted member satisfaction measures
  • Increased efficiencies and quality assurance

Find Out How We Fuel Accelerated Performance

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