- EqualizeRCM team does retrospective and prospective review on provider’s clinical documentation and assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program.
- We help in identifying gaps in data collection and submission by improving risk score accuracy in accordance with appropriate reimbursement requirements.
- Comply with CMS guidelines, NCQA requirements and Medicare Advantage Plans.
- We have risk adjustment and coding expertise in HEDIS review and retrospective chart review with quality coding and monitoring of appropriate clinical documentation.
- We ensure member encounter data is being accurately documented and all relevant diagnosis codes are captured.
- We perform analysis and provide formal feedback to providers on a regularly scheduled basis.