RETROSPECTIVE CHART REVIEWS

THE BACKBONE OF A SUCCESSFUL RISK ADJUSTMENT PROGRAM

At Episource, Retrospective Chart Reviews have been the focus of our coding expertise since 2009.

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OVERVIEW

We use only experienced certified medical coders, with over 1,500 coders worldwide. Episource provides these services to many of the largest healthcare organizations in the U.S.

As HCC thought leaders, we provide flawless execution and outstanding client service, placing a major focus on coding guideline reviews and industry updates. We accurately report patient risk profiles based on the capture of risk-adjusting ICD-10 codes, ensuring payers are appropriately reimbursed for treating their members.

BENEFITS

Superior coding accuracy driven by better people, training, technology, and processes

Unmatched transparency and access to reporting

Data validation to mitigate audit risk

Client customizations (guidelines, coding output formats, comment codes, reporting)

Greater member and provider level insights

Confidence – no shortcuts in compliance, training, or management

KEY FEATURES

Key Information

We provide retrospective coding services for Medicare, Commercial/HIX, and Medicaid Lines of Business using specific models: CMS-HCC, HHS-HCC, and State Specific Medicaid Models.

This review identifies key diagnoses that are:

  • Received on claims and can be validated by medical record documentation
  • Not received on claims supported by the medical record
  • From claims that the medical record does not properly support (and the underlying cause of that lack of support)
  • On the medical record but lack proper support, indicating opportunity for future analysis and/or provider education

 

Episource provides all of these findings through our online portal, epiConnect.

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Episource Acquires Peak Risk Adjustment Solutions.Learn More >
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