Risk Adjustment Factor (RAF) Optimization

  • Chart Reviews done for coding education and documentation Improvement.
  • Gap Analysis (documentation vs coding).
  • Remedial Help (Coder/Physician Education including Template modification).
  • Average RAF scores improved from 0.5 to 1 - 1.25 (Medicaid).
Case Studies
Claims Management - Process Innovation and Technology Result in Cost Reductions
The Challenge: Prohibitive labor cost and considerably higher turnaround time due to large number of manual adjudications resulting from mismatched information between enrollment data and provider data.
Provider Data Management - Process Innovation and Technology Result in Cost Savings
The Challenge: A cost intensive update process required checking data on all provider information update forms, rather than the ones which were actually changed (typically only 40%).