Case studies

Three Key Questions to Evaluate the Effectiveness of Your Risk Adjustment Coding Platform

Five Steps for Health Plan Executives to Boost Coding Accuracy Efficiency


here’s no denying that risk adjustment is the new reality. As the healthcare industry continues its shifting momentum toward value-based reimbursement, the question is no longer whether your organization will embark on a risk adjustment path, but how you can do it most effectively and efficiently—all while continuing to provide affordable plans for comprehensive, high-quality patient care.

Initially, many healthcare organizations turned to third-party risk adjustment vendors in the hopes of better navigating the many aspects of retrieving and coding numerous patient records. Perhaps your organization was one of them. But as compliance standards grow more stringent, coding accuracy becomes increasingly critical, and audits ever more likely, you might be wondering if outsourcing your entire risk adjustment program is still a wise move.

You may be asking:

  • Are your vendors giving you enough visibility into their actions?
  • Do you need to cut costs?
  • Are you satisfied with your vendor’s coding accuracy?
  • Are your internal resources equipped to manage the rising influx of patient charts?
  • Are you tired of feeling like risk adjustment is something you should control—but can’t given your current configurations?

If these issues sound familiar, evaluating the effectiveness of your risk adjustment program could help you achieve greater efficiency and productivity. But what exactly should you change? And how do you find the right platform and, if needed, the right vendors to meet your needs?  

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