CMS has already released PY2020 audit selections, with new RADV audits expected approximately every three months. Whether your team needs help with chart prioritization, retrieval, coding review, financial exposure analysis, or overall audit strategy, Pareto can help you respond with confidence.
Translate plan-level goals into clear workstreams, timelines, and KPIs across risk, Star ratings, and payment integrity.
Pair qualitative and quantitative risk adjustment assessments with risk documentation improvement to increase coding accuracy, completeness, and encounter data quality.
Establish roles, governance, and cross-functional cadences, then deliver targeted performance improvement initiatives for sustained Star ratings lift, revenue recovery, and compliance.
Equip providers and members with practical playbooks, message maps, and workflows, and configure dashboards, self-service analytics, and ad-hoc reporting for internal teams.
Build accurate, transparent forecasts tied to strong data governance and integrity standards.
Implement documentation standards, traceability, and compliance workflows to reduce risk and improve readiness.
Assess Star performance across measures, member engagement initiatives, and operations to identify the highest-impact opportunities for improvement.
A dedicated focus on MA, Medicaid, and Exchange means our advisors bring practical, current-state expertise
You get seasoned operators paired with Pareto’s analytics and platform solutions—which means faster analysis, transparent methods, and durable change
We structure work around quantifiable objectives, ROI tracking, and clinical documentation so results are measurable and compliant
Gain actionable insights in days, not weeks. We share our work and leave your team stronger—there are no secrets and no black boxes
Vice President, Risk Adjustment Consulting
Vice President, Quality Solutions
Principal, Risk Adjustment Consulting
Director, Risk Adjustment Consulting
On June 28th, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released the Affordable Care Act (“ACA”) Risk Adjustment Transfer Payment results for the 2018 benefit year. Within days
Policies and standards that create a single source of truth; enables transparent analytics and audit-ready reporting.
Completeness and accuracy of encounter submissions; key to compliant risk revenue and audit readiness.
Roles, governance, and workflows that make risk adjustment factors (RAF) capture accurate, repeatable, and defensible.
Methodology to connect interventions to financial and quality outcomes; required for accountable decision-making.
A CMS audit program that verifies the accuracy of submitted diagnosis data and payment.
CMS quality metrics (including Consumer Assessment of Healthcare Providers and Systems (CAHPS) and adherence) that drive bonus payments and plan competitiveness.
Pareto Execution Consulting delivers a focused government‑program lens, transparent analytics, and a commitment to leave behind durable operating models—not just decks.
Yes. Pareto aligns sources, resolves gaps, and stands up governance so cross‑functional teams work from the same truth.
Pareto specializes in MA, Medicaid, and Exchange programs and support provider‑sponsored plans and other risk‑bearing entities.
Pareto Intelligence is a healthcare analytics and technology company that helps health plans in government-sponsored markets improve financial performance and regulatory compliance. Our platform delivers actionable insights across premium reconciliation, risk adjustment, Stars, and member engagement—so plans can recover revenue, close gaps, and stay competitive. With support fromour consulting team, we help clients not only identify opportunities but execute with precision, ensuring that strategies translate into measurable outcomes.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
