Risk Adjustment solutions

Help ensure compliant, accurate compensation for your members’ risk burden

CMS RAC

Risk adjustment programs are complex, and their successful management requires maintaining complete compliance while ensuring your health plan’s risk burden is appropriately documented in medical records and encounter submissions. Knowing which risk adjustment tools to use—and when to use them—is critical to ensuring timely and consistent revenue payments. In addition, the regulatory environment changes frequently, and government audits are becoming more common. The stakes are high. You need a partner with extensive risk adjustment experience, one that you can depend on and trust.

Cotiviti provides comprehensive, end-to-end prospective and retrospective risk adjustment services and support for health plans, combining technology, artificial intelligence (AI), analytics, and deep subject-matter expertise to ensure risk-associated revenue is optimized while maintaining appropriate compliance. We provide full transparency at every stage, so you always know the status of your risk adjustment program.



Use our Medicare risk adjustment calculator and get an estimate of the results you could be achieving with Cotiviti.

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From the Cotiviti blog

mitigating the impact of COVID-19 on risk adjustment and quality scores

Learn how health plans can use proactive telehealth and remote care strategies to help mitigate the potential negative impact of the pandemic on risk adjustment and quality measurement programs.

Read the blog

 

Our comprehensive Risk Adjustment solution suite allows you to use one partner and leverage your data across the workflow to optimize both retrospective and prospective programs.


Metrics that matter

>$2B

in appropriate incremental risk adjustment revenue delivered to clients in 2019

Delivering better results

>90%

medical record retrieval rate since 2017

A commitment to quality

>95%

chart coding accuracy since 2017

Submissions success

>99%

acceptance for encounter submissions in 2019

Complete prospective and retrospective risk adjustment solutions to help ensure optimal and appropriate reimbursement

Chart Risk Adjustment

 

risk_adjustment_suspect_analyticsSuspect Analytics

Risk adjustment suspect analytics to identify members with potentially undocumented conditions for prospective and retrospective targeting

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risk_adjustment_medical_record_retrievalMedical Record Retrieval

Achieve >90% medical record retrieval success with a streamlined solution

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Prospective Assessments

Risk adjustment member assessments in a home or alternative provider setting including remotely via telehealth

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RISK_ADJUSTMENT_MEDICAL_RECORD_CODINGMedical Record Coding

Achieve >95% coding accuracy for optimized compliance

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risk_adjustment_submissionsSubmissions

Risk adjustment submissions solutions with >98% acceptance

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Download the Risk Adjustment brochure