Risk adjustment scores and quality measures are critical factors in optimizing revenue for health plans and providers. SCIO® harnesses the data that drives CMS risk adjusted methodologies and provides usable insights to clients to maximize revenue. Our products and services enable plans and providers to integrate Medicare risk adjustment with HEDIS and Stars monitoring to support quality initiatives.
Risk Adjustment: Risk adjustment analytics aligns revenue with expected costs of care and tracks HCC trends so organizations can easily create suspect lists to support retrospective and prospective collection programs. SCIO® provides actionable information in identifying and managing patient populations and their related RAF scores, driving CMS revenue.
Quality Measurement: SCIO® allows plans and providers to gain efficiencies by integrating Medicare risk adjustment and HEDIS/Stars prospective activities. All measures included in the solution are NCQA certified. Working to improve RAF scores and quality scores go hand-in-hand and when you do both, you can have an even greater impact on the quality of care you provide and revenue you generate.
- Accurate Medicare Advantage Risk Scores: Ensure that CMS reimbursement is aligned with the expected costs
- Improved Quality Measures: Ensure that conditions are identified and treated
SCIO’s Quality Measurement capabilities include:
- HEDIS Results
- Stars Results
- Pay for Performance (P4P) Results
SCIOClarity™ Risk Adjustment and Quality Analytics is a Medicare risk adjustment software solution the supports improved risk adjustment scores, enhances quality ratings and helps ensure continuity of care.
SCIOClarity™ RAPS Error Correction is a simple, hosted software that identifies and corrects RAPS errors in CMS rejected diagnoses.
SCIOClarity™ Chart Validation is a retrospective service that retrieves and analyzes member medical records to capture missing- and confirm existing diagnosis codes used in risk adjustment and quality initiatives.
SCIOClarity™ Inpatient Data Pursuit is a full-service hospital data collection service for health plans that eliminates missing and under-reported diagnoses codes related to inpatient stays.
SCIOClarity™ Member Outreach & Provider Collaboration is a prospective end-to-end service for closing care gaps. The service includes provider engagement, member outreach, data collection, coding and data entry.
Key Levers to Manage the “Risk” in Your Risk-Based Contracts
Held on: February 15, 2018
The Risk Adjustment Rallying Cry
Held on: November 30, 2017
Risk Adjustment Round-Up: Reviewing the CMS Call Letter and Other Trends
Held on: May 24, 2017
Navigating Risk Adjustment Headwinds in 2017
Thu, Jan 19, 2017
The Risk Adjustment Treadmill: Keeping Pace in an Ever-Changing Market
Held on: Thu, Jul 14, 2016
Discover how you can increase your Risk Adjustment Factor using SCIOClarity Analytics