Quality and Risk Adjustment

The MHM Team works hand in hand with physician practices and leverages a combination of footwork, hands on physical efforts along with our leading-edge machine learning and artificial intelligence, and electronic medical record acquisition. Our model and framework streamlines risk adjustment complexity into a reliable process, which operates throughout the year rather than just the last 45 days, allowing the easy identification, documentation, and condition and code validation

Undocumented “suspect” conditions and “prospective” codes

Machine-learning algorithms build prioritized lists of suspected chronic conditions, making it easy for physicians to quickly investigate and resolve these gaps during patient visits.

Monitor Risk Adjustment Performance

Monthly KPI reporting drives practice-, physician- and member-level performance insights to inform course corrections and to drive accountability.

Retrospective Adjustments

Our best-practice retrospective solution scans electronic patient charts to address well documented but not-yet-submitted chronic condition diagnoses.

Prospective Adjustment

Finding un-coded or under-coded conditions. Expert human enhanced with automated technology reviews 100 percent of available medical data including progress notes and claims data. Results are reviewed by a certified medical coder for final confirmation.

Fast Accurate HCC Coding

Technology-assisted chart review enables fast, accurate and compliant HCC coding.