Payer Solutions - EqualizeRCM Services

Payer Solutions

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  • EqualizeRCM team does retrospective and prospective review on provider’s clinical documentation and assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program.
  • We help in identifying gaps in data collection and submission by improving risk score accuracy in accordance with appropriate reimbursement requirements.
  • Comply with CMS guidelines, NCQA requirements and Medicare Advantage Plans.
  • We have risk adjustment and coding expertise in HEDIS review and retrospective chart review with quality coding and monitoring of appropriate clinical documentation.
  • We ensure member encounter data is being accurately documented and all relevant diagnosis codes are captured.
  • We perform analysis and provide formal feedback to providers on a regularly scheduled basis.