Payers

Risk Adjustment/Documentation and Coding Services

We have a team of certified professional and experienced coders and clinical documentation improvement (CDI) specialists to offer documentation and coding services to assist primary care practices in optimizing revenue cycle management and ensuring compliance with regulatory requirements for both FFS (E&M) and VBC Hierarchical category conditions (HCC). These services involve capturing and documenting patient encounters, medical history, diagnoses, treatments, and procedures in a structured format according to coding guidelines such as ICD-10 (International Classification of Diseases, 10th edition) and CPT (Current Procedural Terminology).

They provide training and support to healthcare providers and staff on proper documentation practices, coding guidelines, and documentation improvement strategies which play a crucial role in the financial viability and operational efficiency of primary care practices. By ensuring accurate and comprehensive documentation and coding, these services help maximize reimbursement, reduce claim denials, capture risk scores, and minimize compliance risks. Additionally, they contribute to improved clinical documentation integrity, which supports better communication among healthcare providers and facilitates continuity of care for patients.

Quality and HEDIS Measures

Collaborate closely with payers to improve quality and Healthcare Effectiveness Data and Information Set (HEDIS) measures through strategic initiatives and data-driven interventions. Help develop tailored strategies and interventions to address these gaps, such as care coordination programs, preventive care initiatives, and population health management strategies from a health care system perspective. With the support of our experienced team, we can help you in implementing operational and performance improvement initiatives, monitoring progress, and evaluating the effectiveness of interventions.

Advisory Services

Offer a range of general advisory services to payers, supporting in navigating complex challenges and achieving payer focused strategic objectives. These services include strategic planning, market analysis, regulatory compliance, operational efficiency improvement, and risk management. We can offer strategic insights, practical solutions, and expert guidance to help navigate the complexities of the healthcare industry and achieve business objectives.