Spotlight On Risk Adjustment Solution And Revenue Forecasting To Ensure Ultimate Success The connection between the risk adjustment solution and the revenue cycle is developing over time. More providers are inclined to engage in larger risk contracts under value-based care. This leads to a shift from conventional fee-for-service models. Retrospective reviews have historically dominated risk adjustment for supplemental submissions.
For complete and accurate risk capture, provider organizations must find a convenient alternative to multi-year reconciliations due to cash flow pressures. HCC coding is therefore moving from a retrospective workflow into a daily revenue cycle process due to internal incentives.
This is one of the main principles that led to the development and accuracy of risk adjustment solutions and revenue cycles. Further, how else might this "upstream" approach to HCC coding address other unique challenges? 1. 2. 3. 4.
Larger and quick care funding Supported Compliance Better care quality Viable-real-time data
Regarding the benefits of risk adjustment solutions, NLP-based technology and data analytics play a crucial role. NLP helps providers and health plans to capture extraneous and appropriate revenue. Some critical steps should be taken to support risk adjustment solutions and revenue cycle goals. For example: Incorporate HCC operations into the overall revenue cycle plan. Revenue cycle leadership needs to recognize where the riskfocused coder review will situate in the larger cycle. It is crucial to comprehend the broader impact on the revenue cycle metrics. The organization must align the elements according to a comprehensive strategy that optimizes the overall performance of each of the revenue streams. Understanding the Contracts Understand the possibilities of risk shared with payer partners. It can alter depending on the contract year. The risk share affects revenue expectations and assists in regulating the scope of HCC coding operations. The impact of early, partial-risk contracts on traditional FFS revenue reduces with the adoption of full-risk and capitation arrangements, and comprehensive risk coding becomes more critical.
Risk capture helps you determine your specialties and chances of high performance Primary care providers offer the documentation of critical clinical data. But several specialties can impact risk adjustment, such as those who address severe health conditions: endocrinologists, rheumatologists, OBGYNs, cardiologists, etc. They will make appropriate decisions when selecting how to route patient encounters via coder reviews if they have an internal grasp of the prevalence and mix of HCC-eligible documentation within a practice.