Machine Learning Approach for Medicare Risk Management

The experts at Opes Solution helps to cover the costs of granting the covered benefits under Medicare Advantage enrollees. They help the enrollees by a risk management system which includes various complex conditions.

Under Medicare Advantage Risk Plan, every beneficiary is assigned a risk score or a value regarding gender, age, health status, etc. The risk score of the beneficiary is important for predicting the related health cost. The scores are multiplied by the base payment amount of the plan. Then the risk-adjusted base payment is added with the rebate to determine the total reimbursement.

At Opes, we support the Medicare Advantage Risk Plan. Prediction of the costs of care is measured accurately. Beneficiary with complex needs can rely on our experts and the risk adjustment plan for extracting most of the amount. We work with various medicare advantage plans and models for supporting innovative health plans. We will help you to:

• Ensure the integrity and accuracy of the data submitted for the risk score.
• With the help of coding instructions, will submit data elements from acceptable data sources
• Plan Sponsor determines whether the diagnosed codes are submitted unorganized; responsible for erasing the submitted codes faster.
• Reconcile and receive the risk adjustment resorts timely. The diagnosed codes and deleted codes should be taken care of frequently.
• Sumit the diagnosed codes and document them in the medical records.