MedKoder, LLC to Pilot Proprietary Risk Adjustment Management Technology for ACA Providers

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We are excited to release our innovative ACA Risk Adjustment technology into the marketplace to enable our clients to achieve high levels of Risk Adjusted accuracy.

MedKoder, LLC is currently expanding acceptance of requests to pilot a one of a kind risk adjustment management solution for health plans or health systems providing coverage in the Affordable Care Act (ACA). Until recently, MedKoder’s clientele were health plans and health systems that were in risk-based contracts for the Medicare Advantage (MA) population. Because of the precision of MedKoder’s technology to accurately identify, capture and submit HCCs in the MA population, many of their customers requested a solution for their ACA population as well. In response, MedKoder is proud to begin accepting requests from providers and payers to pilot their unique ACA model to ensure accurate premiums based on the true acuity levels of their patient population.

MedKoder’s Risk Adjustment Management Technology has discovered significant revenue recovery for the MA population with an average return of 20:1. MedKoder’s RAM technology offers a retrospective or concurrent analysis of encounters to identify and validate HCCs (Hierarchical Condition Categories). This 100% encounter review is validated by in-house specialized HCC consultants and returned to the client for submission. It is the only complete solution combining technology and service currently available on the market.

MedKoder’s ability to work in the ACA market could not come at a better time as insurers collectively incurred $2.87 billion in losses, which far exceeded the risk corridor boundaries. Because of this, CMS was only able to pay out $0.126 on the dollar to insurers owed payments, although they did vow to pay the full amount owed over the lifetime of the program. As a result, many insurers and CO-OPs could no longer serve the ACA population.

With MedKoder’s proven RAM solution, MedKoder clients aim to capture accurate coding to the highest level of specificity that will appropriately reflect the patient population and accurate reimbursement related to those acuity levels. Regarding the release of MedKoder’s proprietary ACA risk adjustment management technology, Brian Audler, Medkoder President and CEO, says “We are excited to release our innovative ACA Risk Adjustment technology into the marketplace to enable our clients to achieve high levels of Risk Adjusted accuracy. We are making significant investment to provide our clients with the most innovative population management technology available, and it is extremely gratifying to see those investments help our clients and the patients they serve.”

If your organization is interested in being considered for a pilot of MedKoder’s RAM model for your ACA population, please direct inquiries to support(at)medkoder(dot)com or call 985-503-7329.

About MedKoder, LLC: MedKoder is a ‘full-service medical coding management services provider’ offering expert medical coding in all physician service lines and inpatient / outpatient facility coding, medical risk adjustment management, DRG coding management, coding education, clinical coding documentation improvement, revenue integrity, and revenue cycle consulting. For further information, please visit the MedKoder website at or call 1-800-421-9718.

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Bonnie Lavigne
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MedKoder, LLC
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