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Risk Adjustment software solutions

Healthcare Risk Management Software Solutions


Healthcare Risk Management Software Solutions

OSP’s healthcare risk management software solutions offer users powerful insights to assess potential liabilities and to eliminate the need for sourcing services and technology from multiple vendors. Our healthcare risk adjustment solutions have become increasingly relevant as the latest health reforms have redefined the worth plans that should conduct business. Through innovative technologies in healthcare risk management, we provide an integrated set of tools that offer suspect targeting, data validation, encounter data submission, risk trending, suspect analytics, and more. OSP’s medical risk adjustment & reimbursement solutions offer financial acumen by identifying and prioritizing claims by the liabilities involved and positively impacting the revenue. Our solutions help to reconcile discrepancies and to bring balance to the demands of payers and government.


The common bottlenecks which might slow down your business growth


Unstructured Data

Volumes of disorganized medical data make the risk adjustment process tedious, and data mining a daunting task.


Declining Reimbursements

The transition from fee-for-service to a value-based payment model has caused confusion and increased risk vulnerability.


Complicated Processes

The requirement of expertise required for medical billing process owed to the complexities of compliance.


Resistance Toward Technologies

Conventional procedures are preferred and resistant to evolving technologies, causing higher risk susceptibilities.


Higher Workforce Requirement

Medical billing employees and coders are spending more and more time executing menial tasks that could be undertaken swiftly and efficiently by automated systems of AI technologies.


Unprecedented Workload

Considering the current growth of this aspect of healthcare and its expected rise in the U.S., a robust system is the need of the hour.

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Healthcare Risk Management Software for Increased Accuracy and Efficiency

Applying risk adjustment solutions to reduce overall costs and increase efficiency across the organization


Risk Score Trending

OSP’s healthcare risk management offers seamless integration of all the essential solutions in the gamut of liability management. We deliver standalone risk adjustment solutions that drive strategic growth by providing the ability to anticipate, assess, and minimize potential risks. Through our customized healthcare risk adjustment software solutions, healthcare organizations can easily find, decipher, and monitor residual risk score trends and related metrics like average risk scores, expected risk scores, and more. Our risk adjustment solutions can Identify risk adjustment factor score gaps and prioritize healthcare resources used for liability adjustment activities. Navigate your way to a risk-free organizational atmosphere with solutions that are as beneficial as they are easy to use.

Risk Targeting

Another dynamic feature of OSPs healthcare risk adjustment software solutions is risk targeting – a portfolio allocation strategy that tries to have the same portfolio volatility in every market environment. Gain access to advanced risk analytics tools that offer comprehensive risk assessment and management capabilities. With the healthcare transition to population health management, the healthcare landscape has revolutionized to identify high risk and cost patients. Our medical risk adjustment solutions identify likely candidates for care management programs through comprehensive risk targeting through strategies such as pre-screening of patient outreach. Our solutions are tailor-made to create risk-adjusted algorithms to accurately predict the future costs of patients, their current status, and also patient eligibility for care management.

Flexible Reporting

Self-generate custom liability analytics and access flexible risk reports, score summary, payer and provider targeting, diagnosis history, and payment summaries. Assess potential risks and counter the system’s liability gaps to manage cost reductions and patient payment challenges effectively. OSP is committed to undertaking healthcare risk management by collecting relevant medical records, enabling coding individually and accurately, and, thereafter, delivering sound results. Through healthcare risk management, we enable customized provider-sensitive processes to create beneficial associations with providers. Our flexible reporting solutions reduce manual processes, are comprehensively HIPAA-compliant, and secure enough to carry medical data. Healthcare organizations can adjust risks based on reports that can be generated at regular intervals.

Supplemental Submission Analytics

Gain access to analytics support for decision-making and file creation for RAPS submission and EDPS coding project submission. Ensure compliance with myriad health regulations across multiple geographies within cost and time restrictions. OSP’s custom made risk solutions offer the capability to create a consolidated and detailed view of liabilities and compliance across the entire organization. Through the incorporation of advanced analytical technologies, our reach goes beyond organizational data to access and analyze patient, demographic, and specialist avenues of the healthcare industry that will aid in providing a holistic picture of the liabilities and risk vulnerability. Based on the organization’s specific needs in question, we create primary and supplemental analysis to nullify risks at every level and assist with lowered risk scores.

Suspect Analytics

Identify members with possibly undocumented suspect conditions that are appropriate for prospective and retrospective targeting. Link assessed risks to causes, events, dangers, and other elements of governance, risk, and compliance. Implement the customized risk adjustment parameters and navigate through the risk analytics metrics to monitor the potential liabilities. Identify the undocumented HCCs within targeted medical records using powerful, intuitive, and configurable risk adjustment analytics solutions. OSPs risk adjustment solutions are designed to aid a healthcare organization to create a suspect list toward optimizing revenue. This is executed by a detailed analysis and examination of patient data and using predictive analysis to arrive at sound conclusions. This is enabled through complex pattern recognition tools that are more likely to be accurate than traditional manual methods.

Medical Record Retrieval

OSP specializes in the transition of manual processes to automated risk adjustment solutions that include health plans, exchanges, member medical record data, and supported reimbursements through Electronic Medical Record (EMR) solutions. This eradicated complex and time-consuming procedures of emails, faxes, and couriers for documentable data. With agile retrieval methodologies that can achieve maximized goals, our solutions are customized toward efficient resource utilization, reduced turnaround time, and minimal complexities for providers. Above retrieval, we undertake provisions for aggregation, indexing, and storage or medical records, which can be used for holistic analysis. Through our high power algorithms, we extend the capacity of a healthcare organization to achieve their risk adjustment targets with minimal effort, downtime, and complete transparency.

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What We Offer?

Integrated Risk

OSP offers fully integrated healthcare analytics and healthcare risk adjustment software solutions to help our partners identify and assess the liabilities beforehand, proactively improving revenue and healthcare quality. OSP's healthcare risk management software solutions follow a fully integrated and data-driven approach by combining retrospective and prospective liability adjustment programs. The integrated risk adjustment helps closing gaps in a targeted and efficient manner and yields higher accuracy to liability data score. We enable optimization of risk adjustment opportunities to positively impact revenue through speedy identification of members with high value undocumented medical conditions through data coalition. Finally, we ensure validation and rectify clinical processes with providers through advanced analytical techniques that consistently monitor submission gaps and enable prompt rectification. Data integration is a key strength applied holistically across the entire spectrum of our risk adjustment features.

Healthcare Management


OSP's Medical Risk Adjustment software solutions include liability Analytics to identify gaps in risk adjustment factor (RAF) score and prioritize resources accordingly. Risk analytics facilitates analysis of liabilities based on alternate data sources, such as care and pharmacy management data, to identify all possible risk gaps. We understand that complexities involved in risk adjust programs and, consequently, offer solutions designed toward the specific need of the organization, which aids in successful management and complete compliance. Our comprehensive documentation solutions reduce risk burden through encounter submissions. Within the changing regulatory environment, our experience in the relevant domain has proved to be a major strength. Our risk analytics solutions are geared to solve specific challenges to adjust risks across multiple facets of the organization swiftly and seamlessly.

Diagnostic Support

Risk Data

OSP' Medical risk adjustment & reimbursement solutions offer instant and user-friendly access to all risk adjusting data, including medical claims, coding results, liability assessment data, provider diagnosis distribution, and more. Through comprehensive, proactive, and reactive data storage and analysis, we combine our technological strength with in-depth domain knowledge to offer data transparency across the entire spectrum of medical records. Our solutions can be designed to provide security and transparency based on individual requirements that adjust to personalized risk programs. By efficiently accessing records from multiple sources and across variant systems, we minimize the possibility of provider abrasion and ensure end-to-end access to Electronic Medical Records (EMR) as and when required. OSP has successfully created multiple risk adjustment platforms to simplify system reconciliations that have jumpstarted risk adjustment strategies in a simplified manner.

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