Start your revenue cycle strong by ensuring that critical, and accurate, patient information is in place before patient visits begin.
Health Information Management
Our team of coding experts, with a deep understanding of the healthcare industry and its specialties, paired with smart technology creates a tangible, positive impact on cash flow.
Extended Business Office
AGS Health provides a comprehensive suite of RCM services that are customized for each customer. Our experienced team of experts serves as an extension of your business office.
Analytics and Reporting
Obtain answers to critical questions related to performance benchmarking, root cause analysis, predictive analytics, and operational improvements.
Connect with us
Request a demo
Latest CASE STUDIES
By AGS Health
March 22, 2023
The Centers for Medicare and Medicaid Services (CMS) uses risk-adjustment factors to compute the payment for the beneficiaries enrolled in Medicare or Medicare Advantage plans. In doing so, CMS can make accurate payments for enrollees with differences in expected costs. Lastly, the risk adjustment allows CMS to use standardized bids as base payments to plans.
CMS risk adjusts certain plan payments, such as Part C payments made to:
Medicare Advantage plans receive payment for each covered member from the Centers for Medicare and Medicaid Services (CMS). Risk adjustment changes plan payments to ensure accurate and adequate compensation for providing services and covering benefits. Payment is determined by a member’s risk score, which is based on a member’s predicted health status and demographic characteristics.
Medicare RA CMS Hierarchical Condition category (HCC) model is used to risk-adjust payment.
The high-level checklist below of plan requirements details information about risk-adjustment data collection, submission, reporting, and validation:
Hierarchical condition category coding helps communicate patient complexity and portray a picture of the whole patient. In addition to helping predict healthcare resource utilization, RAF scores are used to risk-adjust quality and cost metrics. By accounting for differences in patient complexity, quality and cost performance can be more appropriately measured. It also helps to improve the quality of patient care. For example, higher scores can trigger the referral of a patient for case management in an accountable care organization (ACO) or help to identify candidates for chronic care management services.
AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth. By blending technologies, services, and expert support, AGS Health partners with leading healthcare organizations across the US to deliver tailored solutions that solve the unique needs and challenges of each provider’s revenue cycle operations. The company leverages the latest advancements in automation, process excellence, security, and problem-solving through the use of technology and analytics–all made possible with college-educated, trained RCM experts. AGS Health employs more than 10,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems.