Ensure Success in Risk-Bearing Contracts with RAMP

FRG is excited to announce the re-launch of RAMP, our Revenue Audit and Monitoring Program designed to support Medicare Advantage plans, risk-bearing provider groups, and chart audit organizations participating in value-based care contracts.

RAMP delivers a quantitative and transparent approach to risk adjustment analytics and revenue monitoring. This helps healthcare organizations identify revenue gaps, track recapture opportunities, and strengthen financial performance across risk-bearing arrangements.

Common Challenges in Risk-Bearing Contracts

Documenting, recapturing, and maintaining accurate coding specificity remains a major challenge for organizations operating under global capitation and other risk-bearing contracts. Medicare Advantage Organizations (MAOs) often struggle to identify the full extent of revenue at risk. Many also have difficulty understanding where gaps in risk adjustment performance exist.

In many cases, unfavorable restatements or incomplete HCC capture can impact financial performance. Engaging provider groups consistently in risk adjustment efforts also remains an ongoing challenge across value-based care arrangements.

RAMP by FRG

Fortunately, FRG offers a recurrent revenue monitoring solution designed to address these specific challenges. FRG developed RAMP to help clients better understand the foundations of risk adjustment and member-level analysis for each payment year they can impact. It also helps organizations develop rational, accrual-compatible bottom-up forecasts for revenue recapture efforts.

Key Features and Benefits

Appropriate revenue alignment drives sustainability. FRG starts with CMS-sourced files, flags conditions considered chronic, and looks for their recapture. We do not rely on suspected conditions from pharmacy sources, focusing instead on the most conservative approach to estimating recoverable revenue. Then we show our work. Member by member, and by payment year, diagnosis, and HCC, highlighting the impact of risk adjustment hierarchies.

We refresh this analysis monthly, reflecting the benefit of natural recapture progress and re-estimating recapture opportunity over time. We model Medicare Advantage using the CMS model, while Exchange populations and Medicaid are modeled using the HHS framework, delivered at scale or individually through our MRA Calculator tool.

No Margin, No Mission

FRG believes health plans and physician groups managing risk for Medicare Advantage, Medicaid Managed Care, and Exchange populations need appropriate risk-adjusted revenue. That revenue is necessary to support the expected costs of care. These are the facts:

With RAMP by FRG, especially when paired with FRG’s AccuReports Cost Containment and Profitability module, teams can prioritize misaligned panels and strategically target investment in balanced coding audits. Teams can also build accurate accruals and set member-level revenue budgets with confidence to support shared savings, surplus, and margin creation goals.

Unlock New Opportunities with RAMP™

FRG’s RAMP™ solution is intentionally quantitative and comprehensive. View transaction-level detail by payment year for each member and see recapture opportunity rolled up by panel and across the organization. Plans and providers can process entire markets of managed membership to understand misaligned practices, inattentive providers and new enrollees.

Not sure where to begin? Consider these options:

• Snapshot – one time report from historical CMS files highlighting opportunity at the organizational level and by provider with member level detail.
• Deep Dive – one-time prioritized audit of a significant number of charts chosen based on a Snapshot. Includes encounter-to-impact process review to identify breakpoints in the risk adjustment coding, submission and capture cycle.
• Passive Monitoring – monthly Snapshots with data archival and reporting showing natural and initiative-driven progress through the annual risk adjustment period.
• Active Monitoring – Passive Monitoring accompanied by regular prioritized chart audits to ensure gains of any Deep-Dive are maintained.

Need an Audit? Contact FRG!

We’re excited to share the potential of RAMP to help risk-bearing health organizations, and we hope you are too! For more information about RAMP and pricing, contact FRG via email at info@frgsystems.com or call 888-466-1025 today.