In this case study, a national MSO managing ACOs and MA plans partnered with 3Gen Consulting to overhaul their risk adjustment operations. The result? A 17:1 return on investment through strategic coding, data submission improvements, and full-spectrum support — proving how expert-led outsourcing can redefine financial performance in healthcare.
When healthcare organizations aim for financial stability and growth, efficient billing and risk adjustment aren’t optional—they’re mission-critical. This case study explores how a national Management Services Organization (MSO) achieved a remarkable 17:1 return on investment (ROI) by partnering with 3Gen Consulting, , for end-to-end risk adjustment coding and claims support.
The Challenge: Fragmented Risk Adjustment Process & Vendor Limitations
A leading MSO—managing multiple Accountable Care Organizations (ACOs), Independent Practice Associations (IPAs), and Medicare Advantage (MA) plans across the U.S.—was facing major challenges with its risk adjustment operations. Their existing vendor provided only partial services, unable to support:
● Identification of documentation gaps
● Comprehensive chart reviews
● Submission of Clerical Error Reopening Request (CERR) forms
With these critical components missing, financial potential was slipping through the cracks. Recognizing the need for a more integrated and efficient approach, the MSO turned to 3Gen Consulting, leveraging their deep expertise in risk adjustment and retrospective chart reviews.
The Solution: Full-Spectrum Risk Adjustment Support with PORT & Expert Coders
3Gen Consulting initiated a retrospective review process, beginning with 6,700 lives in the Mid-Atlantic region (Maryland, Washington D.C., Virginia). The scope expanded each year, ultimately covering 21,000 lives across 8 ACOs and a Medicare Advantage plan by Year 3. Here’s how 3Gen Consulting transformed the MSO’s risk adjustment performance:
● Chart Retrieval & EMR Access: 3Gen Consulting accessed charts from provider EMRs and consolidated the data.
● Technology-Driven Reviews: 3Gen Consulting used its proprietary risk adjustment software, PORT, to conduct reviews and track project progress in real-time.
● Certified Risk Coders (CRCs): Specialists identified coding gaps, uncovered new Hierarchical Condition Category (HCC) opportunities, and documented findings.
● CERR Form Submission: 3Gen Consulting prepared and submitted region-specific CERR forms based on Medicare Administrative Contractor (MAC) rules.
● Financial Summary Reporting: 3Gen Consulting provided comprehensive financial impact reports per product line, including all identified HCC opportunities.
The Results: Tangible Financial Gains and Industry-Leading Metrics
The impact was nothing short of exceptional:
● Chart Retrieval Rate: 93.76% (exceeding the industry average of 89–90%)
● CMS CERR Acceptance Rate: Over 90%
● Expansion: From 6,700 lives in one region to 21,000 lives across eight ACOs and a Medicare Advantage plan within 3 years
Financial Highlights
● $8.9 Million in value from improved data submissions
● $935,000 identified in missed revenue opportunities
● 15:1 ROI from 3Gen Consulting’s direct contributions
● 17:1 ROI including captured missed opportunities
These numbers demonstrate the true value of partnering with a specialized medical billing and risk adjustment provider like 3Gen Consulting.
Why 3Gen Consulting Stands Out
Healthcare providers across the U.S. are turning to 3Gen Consulting for results like this. What sets them apart?
1. Certified Expertise: A dedicated team of Certified Risk Coders ensures every opportunity is captured.
2. Tailored Solutions: Services adapt to regional MAC rules and provider-specific needs.
3. End-to-End Support: From chart retrieval to CERR submission, 3Gen Consulting handles the full risk adjustment cycle.
4. Data-Driven Results: Providers gain deep insight into coding performance and financial outcomes.
Conclusion: A Strategic Partnership for Long-Term Financial Success
This case study is a clear example of how a strategic partnership with the right risk adjustment provider can transform healthcare revenue cycles. By leveraging 3Gen Consulting’s expertise and proprietary technology, the MSO:
● Improved coding accuracy
● Reduced administrative burden
● Enhanced claim acceptance rates
● Realized a 17:1 ROI
For healthcare organizations struggling with fragmented processes, missed coding opportunities, or inconsistent reimbursement rates, outsourcing to a trusted medical billing services company like 3Gen Consulting can be the key to unlocking long-term financial success.
Ready to optimize your revenue cycle with industry-leading expertise? Contact 3Gen Consulting today and discover what measurable impact looks like.