OUR HCC RISK-ADJUSTMENT UNDERPAYMENT RECOVERY SOLUTIONS
Utilize deep analytics and data mining to enhance HCC code identification and reconciliation, greatly improving RAF scores.
As CMS and other leading payers continuously push providers to deliver outcomes based on value, it is imperative that providers get compensated appropriately and completely for managing patient care. As such, TMD employs AI and automation algorithms to identify suspected missing HCC codes both longitudinally and across the continuum of care. The impact is potentially millions in adjusted annual payments to providers and payers, depending on their size and scope.
Impacted Organization:
THE PROBLEM
Risk-adjusted reimbursement is intricate, primarily reliant on the health conditions within the population managed by providers and payers. Failing to account for a single condition can lead to thousands of dollars in annual revenue loss. Furthermore, the healthcare data required to evaluate each member is often dispersed among various electronic medical records (EMRs) in inpatient, outpatient, clinic, and office settings. Consequently, payer organizations often suffer millions in forgone reimbursement.
Average Client Impact:
THE SOLUTION
With extensive experience and a well-established reputation, our certified HCC coders and auditors consistently deliver precise and meticulous work. Through our proprietary data analytics tool, we identify potential revenue gains and losses, revealing missed HCC opportunities. Following this, we conduct educational provider sessions to identify common pitfalls, patterns, and trends, ultimately leading to enhanced RAF (Risk Adjustment Factor) scores.
$2,600 per member per year
