Raapid.AI software

Prospective Risk Adjustment approach is the need of an hour as getting clinically validated actionable data in near real-time at the point of care reduces physician burnout and eliminates the requirement for costly retrospective chart chasing, QA and audits. However, shifting to Prospective approach is difficult and resource heavy using manual retrospective ways.

Starting your risk adjustment program with the right subset of members to pursue risk-adjustable, high-value HCC opportunities with undocumented conditions can be a mammoth challenge.

Retrospective approach leaves healthcare systems and plans exposed to penalties, losses and poor outcomes. It cannot stay compliant due to incomplete documentation and uncaptured conditions because the deadline for resolution has expired. With the transition to value-based care, the downside risk-bearing entities require a deep understanding of the quality, care gaps, and risks inherent in the population.

A exquisite risk-adjustment solution is crucial to accurately lining up incentives and protecting risk-bearing healthcare providers and payers. Today, Risk Adjustment programs, including but not limited to, Medicare Advantage (MA), Affordable Care Act (ACA), Accountable Care Organizations (ACOs & ACO Reach), and Medicaid face challenges in getting timely access to clinical charts, claims, and maintaining highest standards of Risk adjustment coding.