Risk Adjustment
Is 95% Coding Accuracy Good Enough?
Accuracy, efficiency, and compliance: these are all qualities health plans aim to achieve in their risk adjustment. Is 95% Coding Accuracy Good...
After becoming a full-service client only 2 months into their initial engagement, THP expanded into other lines of business and surpassed their chart retrieval goal by 15%
The health plan was contracted to a third party for their submissions but they were growing dissatisfied with their vendor’s lack of flexibility to make customizations to the platform and execute them in a timely manner. The plan knew that greater insight into their data and control over the process was necessary. They required accurate and compliant submissions as well as a customer service team who was accessible and could quickly adapt. “We wanted more transparency and better support [for] what was going on with our records and our submissions to CMS,” said the plan’s Encounter Analysis Manager.
The Challenges:
- Maintain or Reduce Rejection Rate
- Improve Transparency
- Revenue Control
Download the case study to learn more about Episource’s approach and the solutions that were implemented to drive results for this large Puerto-Rican based Medicare Advantage health plan.