Refined risk adjustment that secures the revenue needed to drive better care outcomes. Prospective, concurrent, and retrospective HCC coding for IPAs, ACOs, and payers.
Risk adjustment is the single highest-leverage operational lever for Medicare Advantage organizations, IPAs, ACOs, and value-based care groups. Done well, it ensures reimbursement reflects the true clinical complexity of your patient panel. Done poorly, it creates audit risk and revenue leakage.
Our refined risk adjustment processes secure the revenue needed to drive better care outcomes. We work prospectively, concurrently, and retrospectively — with the right approach matched to each engagement.
Driving VBC performance via risk adjustment:
A disciplined risk adjustment approach drives sustainable performance in value-based care. Our services include but are not limited to:
Prospective, concurrent, and retrospective HCC capture aligned with current CMS guidelines and audit-defensible documentation standards.
Real-time review and coding alongside clinical workflows. Closes gaps at the point of care — yielding up to 4× the value of retrospective outreach.
Identification of missed and undocumented conditions through HCC drop reports, suspect logic, and chart-level analysis.
Quality assurance, dual review, and reporting to support accurate, defensible RAF scoring at the member and population level.
Documentation defense, chart pulls, and pre-audit reviews for RADV and other payer-driven audit programs.
Targeted training on documentation specificity, MEAT criteria, and condition-specific coding requirements.
A structured approach that integrates with your practice management system and EMR to close gaps at the point of care.
Customer provides the most recent claims file (previous 2 years), HCC drop/suspect report, ASM, and any preferred tracking output. We analyze to identify HCCs for the current DOS along with newly added, changed, closed, and deleted codes.
We generate and share a weekly summary of findings — newly captured codes, gaps closed, and codes requiring further provider attention.
Through designated access to your PMS and EMR, our team reviews medical records and organizes findings according to client need and provider workflow.
As the team learns the operational details, we identify additional growth opportunities, refine workflows, and share analytics back with you.
Tell us about your organization and what you need. We'll respond within one business day with a tailored proposal.