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Risk Adjustment

Maximize your Medicare Advantage (MA) plan’s potential with our expert-driven MA risk adjustment solutions. Achieve fair compensation and efficient healthcare delivery.

Data-driven to outperform with RaLytics.

About

Medicare Advantage (MA) risk adjustment is used by the Centers for Medicare and Medicaid Services (CMS) to ensure that MA plans are fairly compensated for the health risks of their enrolled beneficiaries. By adjusting payments based on the health needs of the population, MA risk adjustment aims to promote equitable and efficient healthcare delivery within the Medicare Advantage program.

Advantages

Revenue Optimization

Identify at least 2-6% of missed revenue opportunity.
Facilitate more complete reporting in your encounter submissions.
Leverage the payment submission cycle to optimize revenue and compliance.

Prioritize Resources

Obtain insightful and actionable reporting analytics broken down by provider, beneficiary and disease categories.

Reduce Compliance Vulnerabilities

Reduce audit vulnerabilities by 4-6%.
Strategic management of submission and deletes based on risk of support for conditions in medical record documentation.

Solutions

CMS-RADV & OIG Mock Audits

RaLytics’ Mock Audits provide MAOs with a unique opportunity to identify specific operational challenges, gain familiarity with audit and sampling procedures, and obtain a realistic estimate of audit liability.

Experience all aspects of the two audit approaches.
Get an estimate of financial impact from each type audits at both sample and extrapolated levels.

Payment Cycle Optimization

The RaLytics payment cycle framework enables a consistent and compliant submission delete strategy that improves revenues while providing predictability.

Medical Record Evaluation

The RaLytics platform ingests medical record documentation, scores records based on likelihood to support diagnosis for risk-adjusted payment and delivers insight reports designed to guide or validate payment submissions.
RaLytics offers a medical record review team to perform targeted reviews to validate client in-house coding. RaLytics’ AAPC certified coders leverage our proprietary multiple review workflow to validate all evaluations and ensure highest finding accuracy.

Let's Connect

Revolutionize your healthcare organization with RaLytics™! Our tailored solutions drive excellence for health plans, providers, and government agencies. Contact us today to discover how our expertise can drive success for your organization.