Commercial Payers

Commercial Payers

Worthy Endeavors Inc has expertise in clinical validation, risk adjustment models, and reimbursement models. As a commercial payer you carry considerable responsibility when you are performing managed care for the Medicare population. The risk adjustment model based on HCC’s determines what you are given by the government to manage your pool of beneficiaries. Are you doing enough to ensure that those risk adjusted diagnoses are valid? At Worthy Endeavors Inc, we have experience analyzing data, identifying outlier providers, auditing and clinically validating diagnoses. We can provide auditing to assist you with your OIG or DOJ case, or better yet, audit before you are involved with the OIG or DOJ. 


Recovery Audit 

Risk Adjustment Audit

Target Probe and Educate (TPE) 

MS-DRG validation

APR-DRG validation (multi-State and National Grouper)