Risk Adjustment Coding
Risk Adjustment Coding
We specialize in accurately capturing chronic conditions and patient severity through comprehensive HCC (Hierarchical Condition Category) coding, based on the CMS-HCC risk adjustment models. Our certified coders ensure precise documentation and coding of all relevant diagnoses to reflect true patient complexity. This approach supports accurate risk scores, drives appropriate risk-adjusted reimbursements for Medicare Advantage plans, and ensures full compliance with CMS guidelines—helping your organization remain audit-ready and financially sound.
ACA Commercial Risk Adjustment Coding
We support accurate and compliant risk adjustment coding for Affordable Care Act (ACA) exchange-based plans by capturing all eligible diagnoses that impact a member’s Risk Adjustment Factor (RAF) score. Our certified coders conduct thorough medical record reviews and detailed abstraction to identify and document all relevant chronic and high-impact conditions. By aligning with HHS-HCC risk models and payer-specific requirements, we help health plans enhance RAF scores, ensure appropriate premium transfers, and maintain compliance with regulatory standards—ultimately supporting both financial performance and care quality.
