
The RA Analyzer is a comprehensive Risk Adjustment Solution that provides end-to-end functionality from automated data ingestion to risk score generation (retrospective and prospective)
The RA Analyzer is a comprehensive Risk Adjustment Solution that provides end-to-end functionality from automated data ingestion to risk score generation (retrospective and prospective)
Risk Adjustment (RA) is the “soul” of capitated payments and value-based care programs of the Medicare Advantage (MA) and Affordable Care Act (ACA) plans. As of May 2022, more than 30 million Medicare beneficiaries are enrolled in MA plans and more than 14.5 million are enrolled in ACA marketplace.
Part of the Financial Explorer Suite, the RA Analyzer’s models are based on enrollee health status and demographic factors featuring real-time data pull, retrospective and prospective analysis on cost, payment and scores. CMS-HCC model strives to achieve the accurate predictive ratio of expenditures for subgroups of Medicare beneficiaries. HHS-HCC model has developed tailored algorithms for adult, child and infant population enrolled in ACA plans in every state. These models have ongoing revision to be better, with their complex variables and calculation logic are updated several times in a year. 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. All data ingestion, cleaning and insights generation is done in an automated manner in near-real-time.
We provide a managed solution based on your needs with minimal work for your staff. The 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.
No more fragmented solutions to address your risk adjustment needs. CloudMedx provides a suite of SAAS tools embedded in your existing platform to enable automation in data processing, to enhance decision support with risk profile and cost/payment prediction.
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
Our process: