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.

Using Technology To Improve Claims Management for Healthcare Payers

A recent research report by MarketsandMarkets, the global market research platform, predicted that North America would account for “the largest share of the healthcare claims management market in 2018”. Read more
Case Studies
Risk Score Optimization through CDI
Scope: A major university-based health system wanted a thorough review of their documentation to see if it was supporting the level of care they are providing to the risk adjusted patient population.
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%).