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Trusted Revenue Cycle Partner
For Healthcare Providers
Accurate Risk Adjustment Coding & Documentation Solutions
We provide specialized risk adjustment coding services to help healthcare organizations capture patient complexity accurately, improve RAF scores, and maintain compliance. Our expert team reviews documentation, identifies coding gaps, and supports better reimbursement outcomes.
From precise HCC coding to proactive chart reviews, our solutions help maximize revenue, reduce audit risks, and improve coding accuracy for healthcare providers.
Trusted Risk Adjustment Experts
Accurate & Compliant Risk Adjustment Coding Solutions
We help healthcare organizations improve RAF score accuracy, capture chronic conditions correctly, and enhance reimbursement through precise documentation review, compliant coding, and efficient risk adjustment workflows tailored for value-based care success.
Trusted Revenue Cycle Partner
Trusted by healthcare providers for accurate risk adjustment coding, compliance support, and stronger reimbursement outcomes.
Concurrent and Retrospective Review (ASM Submission)
Concurrent Review is the real-time, proactive review of documentation and coding to ensure all risk-adjustable diagnoses (HCCs) are captured accurately, compliantly, and before the claim is billed.
It ensures:
- No HCCs are missed
- Documentation meets MEAT standards
- Claims are accurate before submission
- RAF leakage is prevented
- Providers receive timely feedback
- CMS return file rejections are minimized
Retrospective submission refers to submitting HCC diagnoses after the patient encounter, based on a review of medical records rather than real-time (prospective) documentation ASM = Alternate Submission Method.
File Acceptance & Submission
- Collaborate with HealthPlan to accept ASM (Alternate Submission Method) files on a monthly or quarterly basis.
Return Files & Data Feeds
- Provide MAO-004 return files monthly.
- Provide MAO-002, 999, 277CA as applicable.
- Ensure timely delivery of CMS response files back to HealthPlan.
Reporting & Analytics
Provide the following quarterly:
- HCC Gap Report
- HCC Prevalence Report
- Provider & Practice Performance Reports Collaboration
- Support HealthPlan retrospective review and ASM submission workflow.
- Ensure data exchange pathways are active, accurate, and timely
Prospective
Unlike retrospective risk adjustment, which relies on months-old claims data and reactive chart chases, our prospective coding service embeds certified risk adjustment coders directly into your clinical workflow to capture every eligible HCC before the claim is ever submitted. We start with a pre-visit chart review that analyzes a member’s historical diagnoses, medication lists, and known care gaps, then deliver a simple, actionable worksheet to the provider at the point of care.
