Risk Adjustment & Healthcare Insights | VBC Risk Analytics

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All Insights

Comprehensive resources on risk adjustment analytics, RAF scoring, medical coding, and healthcare APIs.

Risk Adjustment Analytics

Risk Adjustment Analytics Overview

Understand the fundamentals of risk adjustment, key data inputs and outputs, and how analytics drives accuracy.

Prospective Risk Adjustment Analytics

Learn how prospective analytics identifies risk gaps before they impact revenue and care quality.

Retrospective Risk Adjustment Analyticss

Discover how retrospective analytics validates submissions and prepares for RADV audits.

Payer & Provider Use Cases

Payer Risk Adjustment Analytics Use Cases

How health plans leverage analytics for member prioritization, provider engagement, and revenue optimization.

Payer Risk Adjustment Audit Analytics

RADV audit preparation, evidence completeness, and pre-submission validation best practices.

Provider Risk Adjustment Workflows

Pre-visit planning, in-visit documentation, and post-visit review workflows for providers.

Provider Risk Analytics Use Cases

RAF/HCC capture monitoring, care gap analysis, documentation accuracy, and financial outcome optimization.

Population Health Risk Stratification

Stratify patient populations by risk level to optimize care management and resource allocation.

OIG RADV Audit Findings: Diagnosis Code Validation

OIG RADV audit findings across 10 MA plans — 70–99% error rates, $3.7M–$59M in penalties, and pre-submission validation strategies.

Why Your STARS Ratings Are Stuck — and How to Break Through

Three structural gaps hold MA plans back from breaking past 3.5–4 stars. A closed-loop approach breaks through the ceiling.

CMS-HCC Model

CMS-HCC V28 Model Overview

Comprehensive reference on the V28 risk adjustment model covering 115 HCCs, 26 disease families, and constraining methodology.

CMS-HCC V24 vs V28 Comparison

Side-by-side comparison of V24 and V28 covering HCC changes, coefficient constraining, ICD-10 reductions, and revenue impact.

Clinical Documentation Improvement

Clinical Documentation Improvement for Risk Adjustment

CDI strategies that drive RAF accuracy, reduce audit risk, and improve documentation quality.

RAF Score

What is RAF Score?

RAF score fundamentals, what impacts risk adjustment factors, and how HCCs relate to reimbursement.

RAF Score Calculation

Inputs needed to calculate RAF, diagnoses to HCC mapping, and common calculation pitfalls.

RAF Score Use Cases

How payers and providers use RAF scores for revenue forecasting, care planning, and benchmarking.

RAF Score Automation

When to automate RAF calculation, API integration patterns, and batch processing strategies.

Medical Coding

Medical Coding for Risk Adjustment

Best practices for accurate medical coding that supports proper risk capture and compliance.

ICD-10 Coding Guidelines for RA

Understanding guideline adherence, common issues, and documentation sufficiency requirements.

Medical Coding Compliance Validation

Coding QA best practices, evidence completeness, and compliance validation workflows.

Healthcare APIs

Healthcare APIs for Risk Adjustment

Where APIs fit in risk adjustment workflows, real-time vs batch processing, and integration patterns.

Healthcare API Use Cases

Real-world API use cases for RAF calculation, ICD-10 lookup, NPI verification, and more.

FHIR vs REST Healthcare APIs

Comparing FHIR and REST APIs for healthcare integration, interoperability, and data exchange.

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