Risk Adjustment Retrospective Review

Despite your team’s best efforts, coding oversights occur in every healthcare organization. Over time, those errors add up, making it much harder for health plans and providers to identify risk-adjustable opportunities, intervene early, and deliver the best possible care quality and outcomes.

Edifecs Retrospective Review leverages our market-leading NLP and machine learning (ML) to help health plans and providers more effectively identify missed or improperly coded conditions. Our SaaS-based solution analyzes structured and unstructured clinical data and combines it with claims information to deliver a more accurate and comprehensive picture of population disease burdens.

With Edifecs, health plans and providers can improve coding productivity and accuracy, ensure compliance with regulatory requirements, strengthen risk-adjusted revenue integrity, and maximize value-based program performance.

A 4X Increase in Coder Productivity

Edifecs helps healthcare organizations maximize their coding efficiency. To learn more, get in touch with our team.

grow

Focus coder review efforts on highest-value opportunities
Effectively scale to accommodate larger volumes of data
Enable real-time tracking of coder productivity and accuracy

Increase coder productivity

Improve workflow efficiency to help your team handle more reviews.

reveal

Uncover ~1 additional HCC for every 4 MA or 5 ACA members reviewed
Reduce audit risk with two-way review that highlights adds and deletes
Improve revenue integrity and ensure accurate reimbursement

Ensure correct documentation

Leverage NLP to highlight and correct coding and documentation discrepancies.

target

Identify records coded outside of standard guidelines (e.g., M.E.A.T.)
Isolate and prioritize coding gaps with NLP technology
Spot frequently missed or miscoded conditions for effective provider education

Improve RAF scores

Gain confidence in coding and documentation accuracy.

News & Insights

Beyond MEAT: The 3 Common Operational Problems in Adopting HCC Coding that Providers Face

Discover ideas to enhance provider adoption and performance in value-based programs.

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WEDI Webinar: 3 Risk Adjustment Moves to Make Now

As the OIG continues to audit coding practices and in-home assessment validity, now is the time to ensure your risk adjustment operation isn’t exposing your organization to regulatory risk and penalties. In this webinar, hear the strategic adjustments industry experts recommend implementing now so you can be confident in your ability to sustain value-based care reimbursements compliantly and accurately as CMS continues to refine practices.

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Risk Adjustment for Providers Guide

Complete and accurate risk capture is essential to success in value-based contract performance. This guide examines the four points of opportunity where provider organizations can identify and address gaps to achieve greater financial results, ensure regulatory compliance, and enhance care quality.

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