Risk Premiums  

360Risk® is an end-to-end risk adjustment solution aimed at accurate assessment, improvement and reporting of diagnosis-based capitation factors that drive risk score calculation systems. This facilitates efficient and effective submission of risk adjustment data and drives maximum, appropriate reimbursement from Medicare.

The accurate assessment, improvement and reporting of factors that drive risk score calculation is critical. Failure to do so has significant quality of care implications and critical financial ramifications. That is why 360Risk works within CMS risk adjustment payment guidelines to:

• Process, submit and track data file exchanges with payment agencies.
• Identify high-risk members with chronic conditions.
• Uncover coding improvement opportunities.
• Prevent risk score diagnosis categories from disappearing year-to-year.
• Increase accuracy and completeness of data.
• Predict risk scores and revenue based on a robust set of algorithmic options.
• Integrate with existing resources and programs.
• Manage code improvement and file processing tasks throughout the enterprise.
• Create meaningful progress reports and analytics.