Episource © 2021
Join our virtual event on Thursday, December 2nd at 11am PST

Susan Richards
Director of Risk Adjustment & Coding Education

Susan is a nationally recognized leader in risk adjustment and outpatient clinical documentation integrity. She has served as an active steering committee member for coding organizations such as APPC, AHIMA, and ACDIS.

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Meleah Bridgeford
Senior Director of Risk Adjustment, Analytics

Meleah Bridgeford is the Senior Director of Risk Adjustment, Analytics at Episource. Meleah oversees risk adjustment analytics and services and plays a vital role in supporting our epiEncounter submissions solution. She has over 10 years’ experience within healthcare organizations as well as vendor/consultant organizations.

Two Retrospective Strategies to Optimize Your Risk Scores—Without Causing Provider Abrasion

Co-Presented with Gorman Health Group

Thursday, December 2nd, 11:00am - 12:00pm PT

Due to a global pandemic significantly reducing provider/member interactions, it is imperative that risk-bearing organizations optimize the encounters that did take place and ensure claims submitted to CMS were accurate and contained all needed information.

Unfortunately at this stage in the risk adjustment cycle, cleaning up claims data typically means utilizing retrospective strategies that often compromise provider relationships.

But there may be a better way. Learn from Certified coding and CMS submissions experts about two strategies that can help correct claims data and optimize 2021 risk scores—with zero provider abrasion.

In this webinar, you will learn about:

  • The impact of regulatory changes and COVID-19 on your 2021 risk scores
  • The value of utilizing NLP technology to complete second level reviews on charts coded to “95% Accuracy SLAs” and the benefits this can offer from financial and compliance perspective
  • RAPS-EDS data leakage and how auditing submission/response files can uncover and correct previously submitted claims to optimize risk revenue
  • How to accomplish these tasks without causing any provider abrasion

Jeff De Los Reyes (Gorman Health Group)
Senior VP, Healthcare Analytics and Risk Adjustment Solutions

Jeff De Los Reyes is the leader of the Risk Adjustment division at Pareto's sister company, GHG Advisors. In this role, health plans and providers look to Jeff to enhance, optimize, and ensure superior outcomes related to revenue accuracy and compliance across all government- and state-sponsored programs (Medicare, Medicaid, and ACA).