Risk Adjustment

Granite GRC Consulting Services

Medicare’s risk adjustment-based reimbursement methodologies have the potential to bring great benefits to MA health plans, providers and patients. At the same time these programs require active administration and compliance overview, with requirements that are highly complex and fraught with hazards that can result in reduced quality of care, patient experiences, and lost reimbursement. Successful organizations consistently execute effective strategies and protocols to diligently administer the capture and submission of accurate and complete diagnosis information for each and every patient under the risk contracts.

Granite GRC’s skilled professionals engage with MA plans and provider groups to analyze their claims data, review risk adjustment focused processes and audit medical documentation to identify gaps and address opportunities for improvement in the accuracy and completeness of clinical data. Our experiences drive our shaping of risk adjustment programs and training for our clients, using proven RA strategies, solutions and analytics for Medicare, Medicaid and commercial payors, accountable care organizations (ACO), and others participating in risk adjustment-based programs. Our mission is to improve reimbursement, patient care, and patient experiences. Among our skills, we:

  • Apply advanced analytics to benchmark data and results
  • Target observed weaknesses and trends to customize strategic pathways to success
  • Apply experience and best practices to develop policies and protocols that drive patient and provider clinical engagement and results
  • Fine-tune provider documentation and abstraction of codes from the medical record to improve medical coding and HCC recapture
  • Address compliance requirements through focused solutions centered around accurate diagnosis reporting
  • Investigate opportunities for improvement and make recommendations for risk adjustment focused processes
  • Prepare for CMS and HHS RADV audits
  • Support responses to outside inquiries and legal actions

To learn more about how we assist organizations like yours, please visit our Organizations page, or please fill out and submit the contact form to the right and a Granite GRC Consulting team member will be in touch soon.


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