Risk Score Opportunities (RSO)

More accurate risk scoring begins with RSO.

If plan members are under-coded, your organization could be taking on more risk than it bargained for — and losing revenue. Inaccurate risk adjustment factors (RAF) and risk scores can also result in higher premiums for other members in the risk pool. Wakely Risk Score Opportunities (RSO) helps ensure more accurate coding and risk scoring, using a set of exclusive algorithms to identify and prioritize members most likely to have uncoded conditions.

Finding under-coded members doesn’t have to be overwhelming.

Wakely RSO’s features simplify the task of identifying under-coded individuals:

  • User-friendly design works off a basic data request, making it easy to put together periodic reports 
  • RSO algorithms have been calibrated separately for different markets — choose the one(s) you need:
    • Affordable Care Act (ACA)
    • Medicare Advantage
    • State Medicaid programs using CDPS or Medicaid Rx models
  • Using RSO, Wakely can analyze data at any level you need – including provider group, rate cell, region, and more (depending on data availability)
  • After the algorithm examines all pieces of data together, only cases that pass a confidence threshold appear in the final exhibits

Request a consultation to learn more about RSO.

Put a risk score detective on your team.

Wakely provides a comprehensive report of RADIAL results to guide your EDGE submissions, including:

To identity under-coded individuals, as well as providers and provider groups that may have a higher proportion of under-coded cases, Wakely uses RSO algorithms to examine all the relevant data:

  • Historic data and chronic conditions profile of members
  • Pharmacy utilization
  • Diagnosis data (as some conditions are highly co-morbid)
  • Procedure codes that indicate an underlying condition 

Then we give the results to your organization, which include:

  • Under-coded conditions
  • The reason(s) those conditions have been identified (e.g., due to consumption of a drug that indicates a particular condition)
  • Expected revenue increase after coding the condition

Reports can be customized on request, and outputs can be customized to work with your organization’s reporting systems.

Ready to learn more about RSO?

Request a COnsultation

Unique products and tools.

Wakely has developed these industry-leading products and tools, which empower our clients to make highly informed strategic decisions.

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Wakely National Risk Adjustment Reporting (WNRAR)

Provides risk adjustment metrics from 35 states and 19 million lives.

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Risk Score Opportunities (RSO)

Identifies and prioritizes members who are most likely to have a condition that has not been coded.

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Wakely Plan Valuation Model (WPVM)

Supports pricing, mental health parity compliance, cost and utilization analysis and more.

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Risk Adjustment Payment & Identifying Discrepancies (RAPID)

Gets the most out of your EDGE data.

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Wakely Analytics Health Operations Optimization (WAHOO)

Helps payers and providers optimize financial performance with a complete package of services and tools.

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Wakely Affordable Care Act Competitive Analysis Tool (WACACAT)

Allows users to interactively explore market metrics.

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Wakely Risk Assessment (WRA)

Provides a transparent, open-code, high-performance risk assessment model.

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Wakely Risk Insight (WRI)

Includes two major components: The Medicare National Report (MNR) and WRI-MA. Both pinpoint drivers of profitability and compare them to national benchmark data.

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Wakely Risk Insight National Reporting Project (WRINR)

Identifies key profitability drivers for the individual and small group markets.

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Wakely Medicare Repricing Analysis Tool (WMRAT)

Aids the comparison of payment rates across multiple lines of business, categories of service, geographic locations, and providers.

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Wakely ACA Database (WACA)

Contains the most robust and detailed ACA data available in the industry.

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Risk Adjusted Payments & Identifying Discrepancies for Medicare Advantage Plans (RAPID-M)

Helps plans optimize risk scores by identifying RAPS and EDS inconsistencies

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Risk Adjustment Data Integrity Analysis & Lineage (RADIAL)

Compares multiple data sources to provide transparency in risk score differences.

Risk Adjustment Data Integrity Analysis & Lineage (RADIAL)