Risk Adjustment Clinical Suite | Edifecs

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Identify. Prioritize. Perform.

Complete and accurate risk capture is essential to success in value-based contracts. Effective risk adjustment can improve revenue accuracy, enhance care quality, and reduce compliance and audit risks—but achieving this is often easier said than done. Combing through mountains of clinical data requires time and resources that many provider organizations simply don’t have at their disposal.

The Risk Adjustment Clinical Suite is a SaaS-based, modular solution that seamlessly integrates with EHRs to augment—not undermine—existing clinical workflows. Using AI-derived insights and our proprietary Natural Language Processing (NLP) engine, the Clinical Suite enables provider organizations to simultaneously achieve complete and accurate risk capture for multiple patient populations.

Risk-Adjustment-Clinical-Suite-Infographic

Frequently Asked QuestionsUse Tab to navigate between questions, Enter or Space to expand/collapse answers

How much is a properly coded Hierarchical Condition Category (HCC) code worth?
How are RAF scores calculated?
Numerical weight is assigned to a patient’s demographic factors (age, sex, race, ZIP code, residence, disability status, socioeconomic status, Medicaid eligibility, and institutional status) and to the HCC codes in their chart; the values of the HCC codes are measured cumulatively.

These numbers are added together to calculate the Risk Adjustment Factor (RAF) score. The RAF score is then multiplied by the CMS rate for each individual HCC to calculate the expected annual cost of care.
What is the most common reason for improper payment?