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Medicare Advantage

Risk Adjustment (RA) is the “soul” of capitated payments and value-based care programs of the Medicare Advantage (MA). In 2022, more than 30 million Medicare beneficiaries are enrolled in MA plans.

Our RA models are based on enrollee health status and demographic factors with real-time insights. CMS-HCC model strives to achieve the accurate predictive ratio of expenditures for subgroups of Medicare beneficiaries. Accuracy and speed in implementing these models can make a big difference in revenue by predicting a plan or a practice’s capitation payment or fund transfer as the output results of these models.

Our technology can help you in many scenarios of RA activities, e.g., retrospective review for RADV audit, prospective scoring, reporting and education or as point-of-care HCC decision support.

We provide a managed solution based on your needs with minimal work for your staff. CloudMedx’s RA Analyzer is a comprehensive solution that connects seamlessly with your existing workflows and solutions. It is powered by automation and AI that ensures efficiencies and accuracy in the entire process.

Some of the key components of RA Analyzer include:

1.  Data Integrity\Quality Checks and Integration with EMRs

2.  HCC Risk Analysis – Retrospective and Prospective (Score, Cost and Payment)

3.  Reporting, Education and Data Submission

4.  Retrospective Chart Review, Pre-encounter Chart Review and ICD-HCC guideline at Point-of-Care

5.  Coder Progress, Productivity, and Accuracy Tracking

6.  Closure of gaps in care and Real-time Communication

Please click here for more details.