Revenue & Risk Management

Risk Adjustment Accuracy & Revenue Optimization

Caremetrics’ uniquely powerful, high-ROI Risk Adjustment Accuracy & Revenue Optimization solution is designed specifically for complex, government-sponsored populations. 

Our solution leapfrogs traditional claims-based analytical methods by leveraging proprietary methods for aggregating and “cross-pollinating” multiple data sources in a unified decision support environment.

We help our clients capture clinical information—such as functional skill assessments, care plan notes, laboratory values, and EHR/EMR data—and combine these with consumer self-report, claims data, and other historic information.  The resulting comprehensive database and registry enables a richer and more timely picture of individual consumer severity, and allows our clients identify and document appropriate risk adjustment factors earlier and more efficiently.

This solution is fully compliant with the complex regulatory requirements of government-sponsored risk-adjustment programs.

Caremetrics solutions can be used stand-alone or as an essential adjunct to our clients’ existing risk adjustment workflow, processes and external vendors.  We complement existing methods for HCC analysis, RAPS and other formal encounter submission, chart review, prospective engagement, and RADV audit readiness.

Features:

  • Comprehensive database with automated data mining
  • Registry for tracking conditions
  • Information leakage assessment & remediation
  • Triggers and outbound messaging
  • Reporting, validation, reconciliation and exception tracking dashboards for monitoring efficacy