Risk Adjustment Coding

Risk Adjustment Coding Services

Turning coding accuracy and compliance into stronger financial outcomes

MedCode provides risk adjustment coding services that help health plans and providers capture patient complexity with precision. Our highly experienced and certified professionals, robust review system, thorough documentation, and enhanced compliance ensure accurate HCC coding and optimal RAF scores.

Years of Experience

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Experienced Professionals

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Trusted by 1000+ Companies

Partnering with Health Plans and Providers Nationwide

MedCode is a well-recognized and preferred risk adjustment vendor for organizations throughout the healthcare sector. Our dedicated team follows an efficient approach by creating a perfect blend of expert personnel, rigorous process, and scalable technology.

Our methods simplify even the most complex coding requirements, ensuring compliance, accuracy, and efficiency at every stage

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MedCode’s Unique Approach to Risk Adjustment Services

Certified Expertise

Our coders hold CPC, CRC, and CCS credentials.

Multi-Level Quality Assurance

Each chart undergoes a strenuous process of multi-stage review.

Technology-Enabled Efficiency

Risk adjustment software that adds to the efficiency and turnaround time.

Scalable Delivery Model

Capable teams that flex to meet both steady and surge chart volumes seamlessly.

Regulatory Compliance

Workflows aligned with CMS and payer regulatory standards.

MedCode’s Methodology for Medical Risk Adjustment Services

At MedCode, the foundation of our process is human expertise. Every chart goes through careful review to ensure both precision and compliance.

Prospective Reviews

Early assessment of charts to address care gaps and prevent claim denials.

Concurrent Reviews

Real-time coding support and audit during patient encounters.

Retrospective Reviews

Assessment of past charts & documentation to capture any missed HCC opportunities.

Documentation Review

Applying well-structured and effective frameworks such as MEAT and TAMPER to maintain documentation integrity.

Final Audits

The senior auditors conduct a complete compliance check.

Challenges We Address

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Improving the quality of documentation by addressing gaps and inconsistencies.

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Scaling resources effectively to manage high chart volumes within required timelines.

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Ensuring the integrity of data by the smooth alignment of demographic and clinical data for accurate RAF scores.

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Minimizing compliance exposure tied to CMS and payer audits.

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Delivering tailored medical risk adjustment services for Medicare Advantage and ACA risk adjustment programs.

Frequently Asked Questions

What is risk adjustment coding?

It’s the process of mapping patient diagnoses to HCCs and making sure that the reimbursements reflect true patient complexity.

What sets prospective reviews apart from retrospective reviews?

Prospective reviews address coding opportunities before submission, while retrospective reviews analyze past charts to recover missed HCCs.

How does MedCode support accurate risk adjustment?

Our versatile coding team reviews every chart closely, following a layered quality check process. By catching gaps early, we make sure coding stays in line with risk adjustment protocols.

Can MedCode manage high volumes of charts?

Yes. Our teams at MedCode are equipped to scale coding support as per client needs, ensuring consistent quality and compliance.

Improving the quality of documentation by addressing gaps and inconsistencies.

Optimize Your Risk Adjustment Strategy with MedCode

MedCode simplifies risk adjustment coding with accuracy, compliance, and scale, so your reimbursements stay secure. Work with us to secure your revenue and ensure your coding reflects the full complexity of patient care.