Risk adjustment is the foundation of Medicare payments to PACE (Program of All-Inclusive Care for the Elderly) and other risk-bearing organizations.
AnewHealth helps you ensure compliance, streamline processes and optimize revenue related to Medicare risk adjustment payments with services delivered through Capstone Risk Adjustment Services. Meaningful analytics and expert training will help your staff and providers understand the complexities of risk adjustment so they can spend more time focusing on participant and beneficiary care.
Accelerate success with tailored services designed to help you receive optimal capitated payments that accurately reflect your participant or beneficiary population.
Chart audits performed by certified nurse coder-led teams help ensure encounters are coded correctly for compliance and proper payment. Audits can help identify coding opportunities and provider documentation opportunities, identifying previously documented diagnoses, finding unsupported or poorly supported codes for redaction, and highlighting trends to inform training.
Comprehensive analytics identify and address potential gaps in program operations that impact risk adjustment compliance and revenue. Support includes quarterly reporting for actionable intelligence, promotion of best practices for optimized revenue, dedicated RN-client liaisons for personalized service and systematic monitoring for timely course corrections.
Comprehensive training led by former PACE medical directors who speak the same language as your program clinicians and understand their challenges. Quarterly provider education is based on client-specific audit trends to address opportunities for improvement, with comprehensive documentation guidance.
ICD-10 coding is complex and time-consuming. Because providers may not be trained in this area, a great deal of time and effort can be spent searching for and verifying codes. Our certified and experienced coders understand the technical requirements for data collection and submission for Medicare and Medicaid. Capstone concurrent coding services help organizations:
Remain compliant, including with encounter data requirements
Receive accurate payments
Focus more resources on caring for participants
Enhancements to AnewHealth’s technology, including Natural Language Processing (NLP), which enables computers to interpret and produce language, offers added capabilities.
If you want to know more about how AnewHealth is enhancing outcomes through specialized support services or are interested in working together, get in touch!
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