Hierarchical Condition Category (HCC) Coding

  • Risk Adjustment Retrospective and Prospective Chart Reviews for both MRA and CRA.
  • Correct coding to the highest specificity, based on the provider documentation, to maximize risk scores.
  • Certified, clinical coders (CPC, CCS, CRC) for in-depth, focused chart review.
  • Physician on staff to educate providers on documentation.
  • Validate documentation on all diagnosis codes in chart and codes hitting HCCs.
  • Key documentation errors highlighted.
  • Physician Chart Audit summary reports for HCC coding improvement opportunities and education.
Case Studies
Claims Management - Process Innovation and Technology Result in Cost Reductions
The Challenge: Prohibitive labor cost and considerably higher turnaround time due to large number of manual adjudications resulting from mismatched information between enrollment data and provider data.
Provider Data Management - Process Innovation and Technology Result in Cost Savings
The Challenge: A cost intensive update process required checking data on all provider information update forms, rather than the ones which were actually changed (typically only 40%).