Impresiv Health can improve your diagnosis capture and align your HCC scores to the health status of your members.

CMS regulations and risk adjustment updates present ongoing challenges for payers. In order to maximize reimbursement from CMS, you not only have to eliminate gaps in the HCC data capture process; you also have to calculate risk scores correctly and ensure that your RAPS and EDPS submissions are accepted and paid. Fortunately, we designed our Risk Adjustment Services to boost efficiencies into your risk adjustment program and our services are for organizations with ACA, ACO, Medicaid, and Medicare programs. With these customizable services, your risk adjustment program will gain the efficiencies to ensure appropriate and accurate payments from CMS.

Program Design & Oversight

Drive best practices and strategies across the diagnosis capture, submission, and payment process to ensure complete and accurate capture of risk adjustment data.

CMS Attestation Support

Validate payment accuracy and identify potential discrepancies in your data to maximize risk adjustment revenue and minimize health plan risk.

Interim Leadership and Staffing

We fill vacant positions with health plan risk adjustment & revenue management professionals who can step in and add immediate business value.

Reporting & Plan Performance

Our out of the box reporting packages are designed to increase your bottom line and optimize risk adjustment performance and payment by improving plan revenue and reducing Medical Loss Ratio (MLR).

Enterprise Alignment & Strategy

We promote collaboration from the development of the Plan Benefit Package (PBP) in the Medicare bid process to the revenue capture activities and data sharing with Stars and Medical Management.

Ready To Get Started?

What Does This Mean For You?

Our Risk Adjustment Services ensure your organization’s end-to-end processes align with a positive and early cash flow journey—while helping to save costs. Click through the tabs to see how Impresiv Health can support the success of your Risk Adjustment Program.

Suspect Development

It all starts with screening your members and validating that each of their medical conditions are assessed. Impresiv Health assists you in several areas:

  • Has each member been seen this year?
  • Are there any chronic conditions that haven’t been reported?
  • Have any RADV audit flags been raised?
  • Which providers can be identified as needing support?
  • Do providers need training or operational assistance?
Diagnosis Retrieval

Once we identify gaps in the diagnosis codes capture, we support you in the process of retrieval, monitoring and reporting. Impresiv Health can support with:

  • Understand why the codes are missing
  • Address the root cause and not just the symptom
  • Which method is best for which members: Chart Review, In-Home Assessment or another visit
  • Are you able to reduce retrieval expenses – e.g. compliance stops
  • What additional support is needed for Providers to either avoid audit issues or improve diagnosis completeness and capture
RAPS and EDPS Submissions

We work with you to ensure that submissions make it all the way through to acceptance. It doesn’t help you to submit and be rejected!

  • Has everything that could and should be submitted been submitted
  • Are all of the rejects worked and resubmitted to acceptance
  • What processes and technology can be implemented to reduce submission rejections
  • Complete a RAPS EDPS gap analysis and get to the root cause of any problems
  • Payment validation – ensuring that you’re paid for all accepted risk adjustable diags, and identify any HCCs that you are being paid for that you didn’t submit.

From the initial condition identification through to payment, compliance is a critical component of revenue optimization. We can help you with:

  • Checking for RADV audit flags – a chronic condition submitted only once, even though the member had multiple visits with numerous providers, active stroke or heart attack in the physician’s office etc.
  • Identify and plan corrective action for Providers struggling with proper coding documentation and/or diagnosis completeness
  • Reviewing the vendors to ensure they are meeting the standards set forth in their contract
  • Ensuring the staff meets the criteria set forth by Compliance
  • Actively review your monthly payment for potential discrepancies or concerns