Unlocking Revenue Potential: How Accurate Risk Adjustment Drives Financial Performance
Risk adjustment and revenue cycle management (RCM) appear to be separate functions, with one focusing on clinical accuracy and the other on financial workflow; however, in core value, they’re gradually becoming inseparable as healthcare shifts toward value-based care. While risk adjustment ensures that payments accurately reflect patient complexity, RCM oversees the billing, tracking, and collection […]
Five Practical Tips to Strengthen HCC Coding Accuracy and Risk Adjustment
Accurate Hierarchical Condition Category (HCC) coding remains a major challenge for healthcare organizations. In Fiscal Year 2024, Medicare Advantage recorded a 5.61% improper payment rate, resulting in approximately $19.07 billion in improper payments, the majority of which was tied to discrepancies in medical records or miscoded diagnoses. Since HCC codes are central to how CMS […]
Achieving Precision in HCC Coding and Risk Adjustment
In healthcare, knowing how complex a patient’s needs are isn’t optional; you miss that, and the consequences can be costly, both financially and clinically. Risk profiling is no longer just a box to tick; it directly influences how well financial goals and clinical responsibilities are met. Risk adjustment ensures health plans and providers are fairly […]
