Risk Adjustment HCC Coding

RCM Services

Enable Health Plans and Providers to Improve Risk Score Accuracy and Enhance Member Satisfaction with Our Accurate Risk Adjustment Services.

An effective Risk Adjustment HCC coding is critical for healthcare payers and providers to achieve the best clinical and financial outcomes. Organizations with limited staff face challenges in dedicating sufficient resources to streamline the Risk Adjustment coding process. We can help. High Care can scale and meet the needs of all lines of your business with high-level accuracy, reliability, and transparency. Our comprehensive HCC coding solutions include Medicare Advantage, Managed Medicaid, and ACA-Commercial. Our AAPC and AHIMA-certified coders are always staying up-to-date with coding rules and CMS guidelines to ensure compliance. Leveraging our services ensures improved risk adjustment coding, resulting in accurate per-member cost calculations for payers and optimized reimbursements for providers.

Risk Adjustment coding review services

The Hierarchical Condition Category (HCC) coding review process is complicated but essential for effectively managing the risk in value-based care agreements. With High Care, you can obtain complete and accurate medical record coding based on provider documentation to
improve risk adjustment factor (RAF) scores. We provide you with the status report of the risk adjustment program on a regular basis, to ensure full transparency and access to view the operational data at every stage of the process. Our experienced team of experts with deep technical
knowledge assists payers in preparing and submitting precise and complete data to CMS in a timely manner.

Our Services include,

  • Retrospective and concurrent review processes – identify gaps in care and documentation and missed HCC opportunities.
  • Provider education – provide insightful analytics reports and educating physicians regarding clinical documentation improvement (CDI) in order to improve risk scores.
  • RADV audit support – coder education based on RADV audit requirements.

HEDIS Abstraction Services

Our subject matter experts, with diligence and attention to detail, efficiently abstract the Healthcare Effectiveness Data and Information Set (HEDIS) per NCQA guidelines. It is imperative for payers and providers to perform precise and thorough HEDIS measures in order to enhance star
ratings and financial outcomes. At High Care, we provide the right combination of expertise, the latest tools and technologies, and best practices to offer customized solutions that exceed the unique needs of each client.

We provide the following services,

  • Conduct a comprehensive review of patient medical records to verify that care has been rendered appropriately and documented accurately.
  • Provide reports of HEDIS measures with analytics to identify areas for improvement and recommend strategies that align with audit requirements.
  • Develop technology-driven solutions to continuously monitor the HEDIS rates of all your plan members.

Benefits of Risk Adjustment HCC coding services

  • Improve risk scores and achieve optimal financial outcomes.
  • More accurate and timely reimbursements.
  • Improve health outcomes.
  • Reduce operational costs and overheads.
  • Reduce the administrative burden.
  • Deliver valuable population health data.

Learn how your organization can leverage our Risk Adjustment HCC Coding.

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