Prospective Risk Adjustment

Although retrospective chart review ensures that health plans are capturing all HCC related diagnostic codes for members, it does not address the need to provide education and training to providers. At AE & Associates, we are unique, where can offer a staffed physician to educate physicians on documentation.

Prospective provides health plans the benefits of identifying, documenting, and pre-selecting claims before they are reported to CMS.

In addition, as a revenue optimization product, Prospective provides health plans the benefits of a higher financial yield. They will obtain financial compensation 6-9 months earlier for the same date of service than a retrospective.

Benefits of a Prospective Medical Record Review:
  • Improved physician documentation and decreased errors to CMS.
  • Prepares you for RADV Audit
  • Submitting data on the first try which will lower administrative costs
  • Reinforce providers’ documentation and identify providers for ongoing education
  • Monitor providers with continued documentation errors and provide ongoing education to support the errors
  • Identified missed HCCs and determine HCC suspects for potential HCC/RxHCC classification
  • Examine and spot ICD-9 / ICD-10 coding patterns and opportunities for coding improvement