Risk-Adjustment and Value-Based Care
Building and sustaining value through exceptional expertise, decades of experience,
quality services and innovative solutions.
With the steep growth in the number of accountable care organizations, as well as the popularity of Medicare Advantage, managed Medicaid and other value-based payment plans, traditional payment models are in rapid decline. Correspondingly, government authorities are turning their enforcement efforts to these new models. Payers and providers participating in these models are now at enhanced and increasing risk for being audited for compliance with a complex mix of requirements. Granite GRC’s highly skilled and experienced team can evaluate your operations and processes, assess your claims, and provide education to your team helping you to ensure your compliance and long-term success and sustainability.
Addressing Needs and Challenges
For participating organizations, the risk adjustment framework is fundamental to physician reimbursement, patient health management, and supporting value-based programs. In this context many consulting firms limit their focus to increasing financial returns, promising to identify “missed HCCs” or “new diagnosis opportunities” before even assessing your claims or evaluating your processes. Our team focuses on helping you to better understand best practice risk adjustment processes, documentation and coding requirements, and how to increase your accuracy and improve patient care. We help you to achieve optimal reimbursement for your patient population, and in the process help to protect you from negative audit results, improve the efficiency of your documentation and coding, and accurately capture your encounters in your medical records and claims submissions.
“With billions in fines and repayments assessed by the DOJ and OIG since 2020, it’s time for organizations to change their focus from chasing HCCs to preventing disease progression. We build compliant risk adjustment programs for our clients that are focused on patient care rather than HCC optimization. Along with proper documentation and coding, this approach captures all appropriate HCCs, limits audit liabilities, and can lead to better outcomes for the patient.”
– from Sheri Poe Bernard, Director of Risk Adjustment Assessment and Compliance
Products and Services
- Data analytics that can assess risk based on OIG’s targeted codes, common RADV findings, and Granite GRC’s proprietary list of often misused codes that are likely audit targets
- Documentation and coding chart assessments to determine the quality of documentation and coding, including the accuracy of HCC capture
- Clinical medical assessments to measure the integrity of the services documents against the services performed
- Operational assessments to measure the efficacy of processes, including to confirm that HCCs are appropriately added and deleted, and to make recommendations for improvements
- Policies and procedures, including operational and documentation and coding manuals
- Payor and provider contractual assessments, recommendations and negotiations
- High quality, customized training curriculum, delivered on paper, in person or remotely, based upon our findings and/or client requests
Trusted Guidance, Hands-On Approach
Our trusted advisors are recognized authoritiesin their areas of expertise, many with more than three decades of healthcare industry experience working inside enterprises similar to yours. They’ve sat in your seat and have known what it’s like to address concerns from inside an organization. We use that experience to work hard to find great solutions that benefit you.
- We communicate frequently and transparently with you and your team about goals and progress to ensure everyone is coordinated and fully informed.
- We measure and monitor progress regularly and offer reports that let you change course and redirect resources when necessary to eliminate processes that aren’t working and amplify those that are.
- We streamline operations for greater efficiencies that can improve morale and communication, reduce turnover, and so much more.
“Taking on risk contracts as a provider group for the first time is always a difficult undertaking. Granite GRC’s professionals walked us through the specifics and helped us to build a successful risk adjustment coding and documentation program to ensure we were on the right track. Their experts are an effective, thoughtful, and productive set of collaborators.”
– CMS shared savings program executive
Meet the Risk-Adjustment and Value-Based Care Team Leads
Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P
Director Risk Adjustment Assessment and Compliance
Sheri Poe Bernard is the Director of Risk Adjustment Assessment and Compliance at Granite GRC Consulting bringing 28 years of experience in the field of medical coding and documentation and a high level of expertise and a breadth of compliance knowledge that spans business and clinical applications. An accomplished and polished public speaker and author, Bernard has provided dynamic and calibrated training presentations to specific audiences across the country.
Crystal R. Stalter, CPC, CCS-P, CDIP, CCDS-O,
Director of Revenue Cycle and Compliance
Author, speaker and Director of Revenue Cycle and Compliance Crystal Stalter is nationally recognized as an authority in healthcare best practices, medical coding, clinical documentation, natural language processes and artificial intelligence (AI). She brings 20 years of experience in revenue cycle management, compliance, practice management, strategy, training, coding operations, communications, data analysis and more, providing superior guidance and helping healthcare professionals achieve excellence in facility management and patient care.