Risk Adjustment Solution
Getting risk scoring right while remaining compliant is critical to optimizing revenue under value-based reimbursement systems like Medicare Advantage.
Getting risk scoring right while remaining compliant is critical to optimizing revenue under value-based reimbursement systems like Medicare Advantage. However, cross-functional care teams and coding professionals need high-performance tools to understand when changes to patient risk status occur and how to appropriately document for accurate risk adjustment.
Risk Adjustment Tools
The Jiva Risk Adjustment Navigator includes a comprehensive set of tools for maximizing risk-adjustment revenue while remaining compliant, so your organization can:
Keep patient risk scores accurate and up to date.
Identify opportunities for Hierarchical Condition Category (HCC) re-capture as patient diagnoses become more acute year over year.
Organize cross-functional teams around up-to-date data to keep Risk Adjustment Factor (RAF) scores accurate and compliant.
Educate providers on the importance of accurate and complete documentation and risk scoring for appropriate revenue collection under Medicare Advantage and other value-based programs.
Who We Serve
Commercial Health Plans
A one-stop shop for care management, benefits administration, process automation, organizational optimization, and efficiency across the enterprise.
Exceed your value-based care benchmarks leveraging combined clinical and claims data to reduce risk, close gaps, and ensure optimal outcomes.
Accountable Care Organizations
From risk-stratification to gap identification and closure strategies, our capabilities are unmatched, and built in SDOH criteria helps you reach at-risk communities with effective programs.
Medicare Advantage Plans
Built-in risk adjustment to drive consistent success in PMPM payment models and maximize Star ratings performance.
ZeOmega is #1 Best in KLAS for Payer Management Solutions 2022 and 2023
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