Risk Adjustment Factor
THN’s risk adjustment department educates physicians and practices on multiple topics related to risk adjustment factor (RAF). We offer a variety of learning options.
In some cases, physicians may receive compensation for participating and/or continuing medical education (CME) credit.
- Virtual RAF Academy: An evening meeting with 2 sessions is held quarterly. Taught by THN RAF medical directors, the session provides clinical insight into coding as well as practical advice on how to ensure documentation and coding is accurate, compliant and complete.
- Provider Assessment: THN offers a customized report for providers based on a review of your individual charts. The assessment provides insight and examples of where you and your team are coding correctly and where you have missed opportunities to address issues in future visits. The report is reviewed and discussed with the coding educator who identified the findings.
- One-on-One meeting: THN RAF medical directors and coding educators are available for one-on-one discussions with point-of-care providers. We encourage you to take advantage of these opportunities.
Medical Record Review Process
THN is contractually obligated to review medical records on behalf of our payor partners. We use this as an opportunity to capture appropriate risk adjustment codes and use the information to help educate providers and staff on risk adjustment.
We use read-only access to medical records with all the appropriate compliance safeguards in place. Also, we limit the number of team members with access and audit the work done by the team members. We can also accept medical records via secure fax.
Contact your practice performance specialist for more information.
Payor Bonus Programs
- UHC MCAIP: When you participate in this United Healthcare program, you can earn $20 for each suspect medical condition you assess at a care visit with a member. For any members where you address 100% of suspected medical conditions, you can earn an additional $10 for each condition.
- Aetna: You can earn $100 per completed in-office assessment that meets criteria for timely submission and proper completion of the form. This form addresses both RAF and quality gaps.
Meet Our Team
- Lauren Williams, MA, MBA, Executive Director, Health Plan Performance: Lauren.Williams3@conehealth.com
- Gay Ball, CPC, CRC, AHIMA ICD-10-CM Trainer, MRA Project Manager: Lois.Ball@conehealth.com
- Laura Fahey-Higgins, CPC, CRC, Risk Adjustment Supervisor: Laura.FaheyHiggins@conehealth.com
- Sonja Thompson, CPC, CRC, CENTC, Risk Adjustment Supervisor: Sonja.Thompson2@conehealth.com