How to Improve Risk Adjustment Coding Accuracy Using Market Benchmarks

Overview

For risk-bearing organizations, your budget to manage a population is highly dependent on the health status of your patients. Your population’s demographics and comorbidities drive revenue if your organization is in MSSP, ACO REACH or Medicare Advantage.

Risk adjustment documentation and coding initiatives often involve resource intensive chart reviews at the patient level to ensure appropriate and accurate diagnoses submission. With CareJourney data, you can benchmark and compare your populations’ Hierarchical Condition Category (HCC) Risk Adjustment Factor (RAF) scores to peers.

Listen in to this on-demand webinar as our experts discuss identifying risk coding opportunities for improvement using peer benchmark comparisons. You’ll learn how CareJourney data can help you:

• Evaluate the consistency of HCC risk adjustment coding practices, including recapture rates, across a contracted provider network
• Compare risk adjustment coding practices to market averages and peers
• Investigate if an organization has missed opportunities to appropriately code high risk members
• Identify potential fraud and abuse to support a compliance program
• Identify differences in coding practices compared to benchmarks, by specific member cohorts like age, gender, condition, RAF band, and site of service

We will cover the recent 2024 Medicare Physician Fee Schedule proposal to transition to the CMS-HCC model Version 28 and how that will impact ACOs.