5 Steps To Improve Medical Risk Adjustment Process

It is almost impossible to achieve 100 percent accurate risk adjustment coding. Still, some best practices, if followed, can lead to an error-free process, correct risk codes & and increased patient care. This process can include the establishment of appropriate staffing, identifying code gaps, Conducting thorough quality assurance & deployment of advanced technologies.

1) High-quality staffing

It is important to have certified coders with an appropriate level of training. One can maintain quality coders by providing them with updated and regular exercise. It also includes targeted education for staff members who regularly repeat the same coding mistakes. In addition, coders should have proper knowledge about the internal coding standards, ICD coding guidelines, & risk management of the organization.

Always choose a reliable technology services company instead of hiring seasonal coders. Your organization will have a chance to work with the same coders every year, making them familiar with your organization’s coding needs. If your technology service vendor uses off-shore coding, ensure that your data gets stored on-shore to maintain the security of your information. Always opt for a company that has its employees instead of subcontractors to verify the coder’s training and certification.

2) Closing Gaps

This step is carried out to ensure that the captured data is accurate. This process takes place fixing the errors in standard documentation, Standardizing coding procedures, Partnering with an organization to work with trained coders, and last but not least, making use of analytics software to identify 999, 277 & MAO-02 errors before submitting them to CMS. This process can also include reviewing coding patterns & offering providers documented guidelines to fix any standard errors.

3) Reviewing regularly

It is always recommended to have resources to review completed risk adjustment coding, resulting in accurate health plans reimbursements & get your organization prepared for RADV, CMD audits. These reviews include checking documents for accuracy, detail, and consistency. In addition, a second-level study can also be conducted by the coding managers, which can help identify the errors and take a final decision in case of uncertainty by the coder.

One should examine the cause of the documentation gap if repetitive errors are found during the coding review process. Once it has been identified, make coders aware of the mistakes to avoid this in the future. Utilize trained & certified coders to avoid increased errors.

4) Turning to technology

Various tools can help health plans identify gaps & recapture codes. These software’s are developed to prioritize members having the highest HCC recapturing opportunities. After identifying the highest priority codes, this software can also help automate chase list generation, production of attestation letters, & mailing to close the gaps in HCC. Technology needs to be trained to increase their accuracy; hence comprehensive training & multi-level auditing must be in their place. It is essential to leverage the ability of coders & provide them with the necessary resources when applying new technology such as NLP to coding.


Our experienced team at Guhilot will provide you with ongoing insights that will help you understand the drivers of financial & medical risk. In addition, our revenue analysis process involves analysis of the dangers, which calculates potential & historic risk scores determining suspected morbidities, leading to both cost containment opportunities & revenue optimization. For more information regarding our risk adjustment services visit our website.

20 thoughts on “5 Steps To Improve Medical Risk Adjustment Process

  1. You’re so awesome! I don’t believe I have read a single thing like that before. So great to find someone with some original thoughts on this topic.

  2. Superb post however I was wanting to know if you could write a litte more on this topic? I’d be very grateful if you could elaborate a little bit more.

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