Precision HCC Coding.
Audit-Proof Revenue.
Our clients don't just survive audits; they thrive. By accurately capturing the true acuity of your patient population, we typically see a 21% lift in RAF scores while maintaining a 98%+ coding accuracy rate.
Find the Opportunity Before the Visit.
Retrospective review tells you what may have been missed. Prospective review creates an opportunity to identify and address relevant conditions before they become missed opportunities.
Retrospective Review
Look back across completed encounters to identify supported conditions, missed diagnoses, documentation issues, and coding gaps.
Prospective Review
Look ahead using available longitudinal information to prioritize patients, conditions, and documentation opportunities before or around the encounter.
What We Look For
Existing Condition Recapture
Identify previously documented chronic conditions that may require current-year evaluation.
Recapture Opportunities
Pinpoint conditions supported by historical clinical information warranting attention.
Potential Coding Gaps
Identify conditions not reflected in current-year coding requiring clinical evaluation.
Emerging Conditions
Detect clinical indicators that may suggest an emerging condition requiring assessment.
Claim Gaps
Cross-reference clinical information and claims data to identify discrepancies.
Chart Gaps
Flag incomplete or unavailable records requiring retrieval before a coding determination.
Comprehensive HCC Review.
Prospective review is our primary focus, complemented by concurrent and retrospective services for a complete risk-adjustment solution.
Prospective Chart Review
Proactive review of longitudinal patient information to identify actionable HCC opportunities before the encounter.
- Existing condition recapture
- Potential coding gaps
- Emerging conditions
Concurrent HCC Review
Support coding accuracy while care is actively being delivered, addressing potential issues earlier.
- Encounter-level review
- HCC identification
- Coding validation
Retrospective HCC Review
Review completed encounters to identify supported conditions that may have been overlooked.
- Missed diagnosis identification
- Documentation review
- Retrospective gap analysis
HCC Coding & Validation
Expert review of clinical documentation to support accurate, consistent, and documented risk adjustment.
- Clinical documentation review
- Coder review
- Quality controls
Coding QA & Audits
Quality reviews designed to monitor accuracy, identify recurring errors, and strengthen internal processes.
- Targeted audits
- Error analysis
- Corrective feedback
Risk Adjustment Reporting
Actionable reporting that helps organizations understand coding activity, gaps, and operational performance.
- Opportunity reporting
- Quality metrics
- Productivity reporting
From Clinical Data to Actionable Insight.
"The goal is not simply to identify more codes. It is to identify the right opportunities."
Our quality-focused approach helps distinguish potential opportunities from conditions that are appropriately supported for coding.
Patient History & Available Data
Review relevant longitudinal clinical information and available data sources.
Prospective Chart Review
Evaluate the patient record for conditions and potential opportunities requiring attention.
Opportunity & Gap Identification
Classify findings into recapture, coding, emerging, claim, and chart opportunities.
Expert Documentation Review
Assess whether identified opportunities are supported by appropriate clinical documentation.
HCC Coding & Validation
Apply applicable coding and risk-adjustment requirements with expert human review.
Quality Assurance & Reporting
Perform rigorous quality checks and deliver clear, actionable operational results.
Answering Your Critical Audit Questions.
Proactive identification of documentation gaps is the only way to protect your revenue from payer clawbacks.
How can I prepare for a RAC or Payer Audit without panicking?
We conduct proactive, multi-specialty mock audits using certified HCC coders to identify and correct documentation vulnerabilities before payer scrutiny begins.
Why is my RAF score dropping despite seeing sicker patients?
Dropping RAF scores are usually caused by a failure to recapture chronic conditions annually. Our engine ensures all active conditions are accurately documented and coded every calendar year.
How do I stop 'down-coding' from reducing my legitimate revenue?
We provide targeted physician education and precise clinical documentation improvement (CDI) feedback so providers confidently capture the highest appropriate specificity.
How do I keep up with the annual ICD-10 and HCC model updates?
Our elite bench of AAPC/AHIMA certified professionals continuously monitor CMS model transitions (like v24 to v28) and integrate these updates directly into your workflow.
Where are my biggest documentation gaps for Risk Adjustment?
We utilize advanced data analytics to cross-reference historical claims with current encounters, pinpointing exactly where MEAT (Monitor, Evaluate, Assess, Treat) criteria are missing.
Core Architecture
Intelligence in Motion.
ASSESS
Real-time clinical data ingestion from EHR, HIE, and lab manifests.
ANALYZE
AI identifies HCC documentation gaps and predicts potential bottlenecks.
OPTIMIZE
System automates routing shifts for scribes and suggests adjustments.
VALIDATE
Continuous quality monitoring ensures every submission increases ROI.
Ready to optimize your revenue cycle?
Stop leaving money on the table. Get a free audit of your current clinical workflow today.
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Interested in our services?
Have our Subject Matter Expert (SME) contact you at your convenience.