PharmD Live®’s solution ensures accurate RAF scores and compliant documentation to maximize Medicare reimbursement and support value‑based care.
The HCC risk adjustment model assigns a risk score to each Medicare Advantage beneficiary based on documented diagnoses. Accurate coding directly impacts reimbursement: mis‑captured HCCs can cost organizations millions in lost revenuehealthcatalyst.com. Capturing all relevant conditions also ensures fairness and reflects true patient complexity. PharmD Live®’s solution combines clinician expertise, AI‑driven problem list analysis and robust documentation to meet the MEAT (Monitoring, Evaluation, Assessment, Treatment) criteria required for audit readiness.
Our multidisciplinary team (physicians, pharmacists, coders) reviews visit notes, labs and imaging to capture all active conditions.
AI and natural language processing surface undocumented diagnoses and close HCC gaps—improving RAF scores and coding specificityimohealth.com.
Templates ensure each HCC meets CMS documentation standards (monitored, evaluated, assessed and treated).
We track HCC capture across the calendar year, flag expiring codes and schedule follow‑up visits to maintain risk adjustment accuracy.
Provide ongoing education to providers on documentation best practices and evolving CMS rules.
Precise coding yields more accurate risk scores, translating into higher reimbursement and better alignment with patient complexityhealthcatalyst.com.
Accurate risk profiles allow care teams to stratify patients, allocate resources and design personalized interventions.
Thorough documentation and MEAT compliance reduce RADV audit risk and ensure confidence during payer reviews.
Improved documentation supports quality metrics and performance in MIPS/APM programs, CAHPS and Star Ratings.
Our risk adjustment solution is powered by pharmacists and coders who understand medication complexities. By integrating AWV data and problem list analytics, we uncover conditions that might otherwise go undocumented. Through our AI‑driven workflow and expert oversight, providers capture more diagnoses, secure compliant documentation and improve financial performance. We help organizations master risk adjustment, so they can focus on delivering value‑based care.