Services / Risk Adjustment & Coding
Risk Adjustment & Coding
End-to-end risk adjustment analytics with 12 RADV audit defenses and zero adverse findings.
Risk Adjustment Modeling & Optimization
- CMS-HCC V28 and V24 model analytics with crosswalk analysis
- RAF score forecasting with normalization factor and coding intensity adjustments
- Suspect condition identification using pharmacy, lab, and diagnostic signals
- Risk adjustment performance benchmarking against CMS national averages
HCC Analytics
- HCC coding gap identification and closure tracking
- Diagnosis code validation and reconciliation
- Encounter data quality assurance
- Hierarchical condition category modeling
RADV Audit Support
- Pre-audit readiness assessment
- Medical record review coordination
- Extrapolation methodology analysis
- Post-audit appeal strategy and documentation
Encounter Data & Submission Optimization
- RAPS and EDS submission completeness and reconciliation analysis
- Submission timing optimization for mid-year and final sweeps
- EDPS filtering logic review and error resolution strategy
- ICD-10-CM specificity improvement for HCC capture maximization
Clinical Documentation Improvement
- CDI program design and implementation support
- Provider education and coding guidance
- Documentation gap analysis
- HCC capture rate benchmarking
Protect your RAF revenue
Our risk adjustment team has defended 12 RADV audits with zero adverse RADV findings.