Services
Risk Adjustment Coding Services
Overview
As healthcare transitions to a value-based care model, the financial burden is shifting from payers to providers. To succeed in this changing landscape, provider organizations must improve documentation, align evidence, and enhance coding quality to maximize reimbursement. With AGS Health’s Hierarchical Condition Category (HCC) coding services, you can positively impact your bottom line while improving your ability to forecast costs and improve patient satisfaction among high-risk populations.
Our certified risk adjustment coding team leverages proven processes and state-of-the-art workflow technologies to enhance physician engagement and prioritize high-value, high-volume encounters. We also apply artificial intelligence to help identify missing diagnoses, estranged evidence, and other issues to ensure optimal reimbursements and better manage at-risk populations.
AGS Health risk adjustment coders review and code using all types of reviews:
Retrospective Reviews
Deep dive retrospective reviews uncover all types of missed diagnoses, estranged evidence, and other issues often buried in ancillary reports and supplemental documentation.
Concurrent Reviews
Concurrent encounter reviews to ensure all relevant diagnoses and clinical indicators are documented in the patient record and captured for claim submission.
Prospective Reviews
Prospective reviews to prepare physicians for patient visits, provide a list of eligible conditions for review during the encounter, and query for accuracy to maximize your RAF score.
SERVICES PROVIDED
Our highly trained staff can assist with the coding of complex cases for risk adjustment, such as HCC coding, to ensure accurate RAF scoring and reimbursements among patients with chronic conditions.
AGS Health will:
- Conduct high-accuracy diagnostic coding.
- Ensure medical records are complete and accurate based on Hierarchical Condition Categories (HCCs) guidelines.
- Verify risk-adjusted codes and documentation based on industry standards.
- Provide assessment of documentation based on M.E.A.T. criteria.
- Supply dashboards and analytical tools to help you manage your Risk Adjustment population.
- Conduct high-accuracy diagnostic coding.
- Ensure medical records are complete and accurate based on Hierarchical Condition Categories (HCCs) guidelines.
- Verify risk-adjusted codes and documentation based on industry standards.
- Provide assessment of documentation based on M.E.A.T. criteria.
- Supply dashboards and analytical tools to help you manage your Risk Adjustment population.
BENEFITS
Minimize coding errors and maximize reimbursement with risk adjustment coding services
Maximize Revenue
Document and include evidence with properly coded HCC encounters to improve accuracy and ensure patient data, conditions, and severity are properly documented for correct reimbursement for the level of care provided.
Improved Data Accuracy
Mitigate under coding or over coding by ensuring proper documentation and evidence of patient care and utilize data analytics for population health management to make informed decisions.
Adherence to Coding Guidelines
Ensure confidence in understanding the code hierarchy to select the most specific ICD codes and comply with CMS and regulatory requirements while reducing the risk of audits and penalties.
Interested in learning more?
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