With the implementation of a fully risk-adjusted capitation reimbursement model, all Medicare Advantage (MA) Plans are ultimately 100% financially dependent upon the specific documentation of each individual patient’s diagnoses as classified within the CMS Hierarchical Condition Category (HCC) system.  Failure to do so has significant financial ramifications.

MedAssurant delivers the industry-leading, truly “end-to-end” Capitation Risk Adjustment (CARA™) solution designed to identify, analyze, pursue, and document valid diagnoses not otherwise properly or fully captured by a plan’s primary claims systems.

The CARA solution demonstrates impressive return on investment. Whether to maximize future reimbursement rates or to ensure that full reimbursement is recaptured for past periods in final reconciliation processes, CARA assists each MA client to efficiently and accurately implement a system to optimally identify and capture the health characteristics of its enrollees to enable full reimbursement.