Accurate coding and care cap identification are critical for running efficient Medicaid, Medicare Advantage, and ACA commercial programs. However, risk adjustment can be a costly, resource-intensive process. In fact, closing diagnosis coding gaps can be expensive, time consuming and challenging when it comes to engaging providers. To truly gain efficiencies requires a focus on reducing wasteful interventions and being able to identify where improvements are possible.
The webinar will present a case study around Retrospective Medical Record Reviews (MRR) based on our work with regional health insurance providers. Specifically, we will present best practices around risk adjustment (RA) and MRR that have helped regional health insurance providers achieve significant ROI from their RA programs.
AVP Product Management
Blue Health Intelligence (BHI)
Roxanna Cross has substantial health care information technology and product management experience in the healthcare payer market. She has launched and managed many commercial software products and has directed product teams in the areas of Risk Adjustment, Medical Management Decision Support, HEDIS ® Reporting Certified Software, Healthcare Guidance products for Member and Provider Engagement, Member Portals, Provider Portals, Employer Portals, and Claims Processing solutions.