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Medical coding accuracy: It affects your bottom line, and we’ll help you get it right.
Medical diagnoses are often incorrectly coded or not coded at all, adversely impacting your members’ healthcare outcomes and increasing your risk of audits, lawsuits, fines, and incorrect payments from risk adjustment programs.
Milliman IMPROVE analyzes detailed enrollment, medical, and pharmacy data, using a powerful algorithm to zero-in on coding errors and omissions. You get a clear, prioritized assessment of members whose conditions may have been under- or over-coded, along with financial impact estimates. With this information, you can match resources to risks and opportunities and reduce non-compliance with the False Claims Act or risk adjustment data validation (RADV) audit protocols.
Investigate charts, coordinate care, target wellness campaigns, and integrate with electronic medical records to identify conditions upfront.
Allocate resources effectively with coding errors prioritized according to impact.
Limit your exposure to RADV audits and government oversight using the REMOVE module to identify potentially unsupported conditions.
Refresh results as often as you like for real-time performance.
Enjoy the benefit of transparent results that put you (and not the vendor) in control of your investment.
This paper addresses strategies to facilitate an organizational coding completeness initiative and “crack the code” on the tools and methods for increasing risk adjustment management’s success.
This paper introduces the broader concept of risk management adjustment and highlights actions you can take to maintain its long-term success.
This paper explores some of the more useful types of analytics a commercial health plan can leverage to monitor the performance of its Patient Protection and Affordable Care Act block and keep a better risk score.
We share best practices to maximize submissions for External Data Gathering Environment, a requirement under the Affordable Care Act.
This paper outlines action steps health plans should consider as part of their annual EDGE server submission cycle.
An article to introduce the broader concept of risk adjustment management.
EDGE ASSIST is Milliman's end-to-end managed service solution—from data ingestion and manipulation to the final submission and everything in between.
Manage Medicare, Medicaid, and commercial risk adjustment with our award-winning suite of tools and data.
Adopt the healthcare industry’s leading platform for data warehousing and healthcare analytics.
Ask the tough questions. We’re ready for them.