Risk Adjustment and HCC Solutions
Delivering value-based reimbursement support with audit accuracy, efficiency, and clear guidance.
Understanding HCCs
Today, ICD-10-CM coding is ever-evolving and complex. e4health strives to simplify complicated coding methods by providing a thorough understanding of Risk Adjustment and Hierarchical Condition Categories (HCCs).
Diagnoses have an increasing role in reimbursement. The Risk Adjustment (RA) payment model is based on the assignment of diagnoses to disease groups known as HCCs. HCCs capture the severity of illnesses as well as acute and chronic conditions for patients. Risk scores associated with HCCs are tied to reimbursement and based on documented diagnoses.
Risk Adjustment in Healthcare
Risk Adjustment is associated with Medicare Advantage plans (CMS HCC), Medicare Part D (prescription coverage), the health insurance marketplace under the Affordable Care Act (HHS HCC), and Medicaid managed plans. Current projections predict that up to 40% of Medicare beneficiaries will be in Medicare Advantage plans in the early 2020s and up to 50% by 2025. As the healthcare industry’s reimbursement methodology continues to transition from a “fee-for-service” model to “value-based” care, risk adjustment is more important than ever.
Unparalleled Risk Adjustment and HCC Auditing Expertise
Boasting years of experience and the successful review of thousands of records, our credentialed HCC coders and auditors maintain exceptional accuracy and deliver meticulous work. With our proprietary data analytics tool, we identify potential losses and gains and highlight missed opportunities. We then conduct education sessions that determine pitfalls, patterns, and trends that can lead to optimized RAF (Risk Adjustment Factor) scores.
No one is better prepared to handle RA/HCC assessments and education than our e4health subject matter experts. Unmatched expertise:
Credentialed leadership team: RN, RHIA, RHIT, CCS, CCDS, CDIP, CRC, CPC
Advanced knowledge of the CMS landscape
Provided significant consulting input on various federal agency coding procedures
Partnered with providers in leading medical centers to assess, educate, and implement inpatient & outpatient CDI practices
Reviewed over 40,000 records while managing audit processes
Performed the Secondary Validation Audit (SVA) for a Risk Adjustment Data Validation (RADV) audit for the past five years
Presented education sessions that identify pitfalls, patterns, and trends that can lead to optimized RAF (Risk Adjustment Factor) scores
Meet Our Mid-Revenue Cycle Leader
Staci Josten, BSN, RN, CCDS
President, Clinical Revenue Integrity & Operational Excellence
Staci is an experienced Registered Nurse with a bachelor’s degree of science in nursing and CCDS. Staci has an extensive background in healthcare for the past 25 years. She started her career as a bedside nurse in critical care and took care of patients in the pre and post cath lab areas. Staci started her Clinical Documentation Integrity career in 2008 in Des Moines, IA. She was later promoted to CDI Director and later to Regional and National Director of the Health System. Responsibilities included overseeing over 35 CDI programs and 100 CDI Professionals across the United States. In 2015, Staci joined a healthcare staffing and consulting company. During this time, started as manager and promoted to Senior Manager, and then Director. Her responsibilities included overseeing CDI professionals as well as development and implementation of CDI Projects including CDI Assessments and CDI Audits.
Staci is passionate about helping others and enjoys assisting in CDI programs improvements with adequate staffing, ongoing quality reviews, education, and CDI assessments. Staci is a past presenter at state and national for both ACDIS and AHIMA.
Maximum CDI Efficiency Starts Here
The e4health team covers interim management, elbow-to-elbow training, physician adviser mentorship, quality measure abstraction, and everything in between. Schedule a meeting today!
Fast-track cash flow. Improve staff efficiency.
Coding Solutions
Immediately measure impact through increased cash flow, diminished backlog and decreased denials.
Auditing Solutions
Conduct audits and deliver targeted education with our domestic full-time experts.
Denials and Appeals Management
Assess denial trends and tap into valuable education to prevent and manage denials. Our team also teaches you defensive strategies to reduce risk and assist with appeal assessment and submission.
CDM Review
Analyze inpatient, outpatient, and clinic charges maintained in the CDM and impacted by CMS with e4health. We review code accuracy and modifier assignments for compliance and conduct price comparisons versus allowable reimbursement levels.
Education and Training
Mid-Revenue cycle, medical coding, and CDI education and training that maximizes professional performance and optimize outcomes.
CDI Solutions
Capture documentation specificity and maximize efficiency with a consultative approach.
Risk Adjustment and HCC Solutions
Get risk scoring right while remaining compliant with our assessments and education.
DNFB Optimization
Master DNFB cases where bills remain incomplete due to coding and documentation gaps. Discover e4health’s education and continuous improvement programs for healthier bottom lines.
Mid-Revenue Cycle Blueprint
Our mid-revenue cycle lean blueprint workshop is a one-day exercise that will help your organization gain alignment around a mid-revenue cycle strategy and future state path that saves time and money.
Coding Integrity Software Solutions
Access detailed analysis and customizable reporting for any audit type and quickly analyze productivity and reimbursement.