Risk adjustment that is accurate, complete, and defensible under audit
Risk adjustment revenue is only as good as the documentation behind it. BeeReady helps Medicare Advantage plans, Medicaid plans, Exchange issuers, and provider organizations build programs that capture the full documented clinical picture while standing up to Risk Adjustment Data Validation, Office of Inspector General, and state scrutiny.
Discuss your risk adjustment programSound familiar?
These are the situations that bring health plans, provider organizations, and their partners to BeeReady.
- A Risk Adjustment Data Validation audit notice or Office of Inspector General audit has arrived.
- Internal review shows unsupported diagnoses, inconsistent coding, or documentation that does not support submitted conditions.
- Growth, organizational change, or a vendor transition has created gaps in oversight of chart retrieval, coding, and submissions.
- Providers in value-based contracts need documentation education that connects HEDIS, pay for performance, and risk adjustment instead of three separate messages.
Six ways we help
Program assessment and governance
Policies, controls, submission and deletion processes, and oversight of retrieval and coding vendors, assessed against CMS requirements and the line of business, payment model, and population involved.
Medical record and coding reviews
Two-way reviews by certified coders that identify unsupported diagnoses and documented conditions that were missed, with findings translated into education and corrective action.
Audit readiness and response
Mock Risk Adjustment Data Validation audits, medical record retrieval and quality checks, attestation processes, submission quality assurance, and coordinated response when the real audit arrives.
Analytics review and prioritization
Validation of suspecting logic and vendor outputs, prioritization of review targets, and interpretation that separates real issues from noise.
Provider and coder education
Documentation and coding education built for clinicians, covering risk adjustment, HEDIS, and pay for performance in one curriculum. Available as a standalone engagement.
Remediation and compliance integration
Diagnosis deletion, overpayment analysis, and coordination with your compliance officer on reporting obligations, so revenue and compliance are not working against each other.
We approach risk adjustment from the Chief Compliance Officer's chair as well as the revenue side. Programs we build are designed to be explained to a CMS auditor, and education we deliver is designed to be accepted by physicians.
What you walk away with
Typical deliverables
- Program assessment with prioritized findings and an improvement roadmap
- Chart review results with accuracy rates, recurring issues, and recommended actions
- Mock audit results, evidence inventory, and audit response plan
- Vendor oversight tools and monitoring measures
- Provider and coder education curriculum and session materials
Before you call
Do your reviews look for both missed and unsupported diagnoses?
Yes. Accuracy runs both directions. A program that only looks for additions is not defensible, and one that only looks for deletions leaves documented care unrecognized.
Can we engage you for provider education alone?
Yes. Provider documentation and coding education stands on its own, and we often pair it with a focused chart review so examples come from your own records.
Know your risk scores are right before CMS checks
Tell us about your audit, your review findings, or the oversight gap that concerns you. We will outline a scope that fits.