Risk Adjustment
Improve accuracy in healthcare reimbursements with expert risk adjustment services.
Risk Adjustment
Improve accuracy in healthcare reimbursements with expert risk adjustment services.
Our Risk Adjustment services ensure accurate capture of patient health status, helping healthcare organizations improve coding quality, optimize reimbursements, and maintain compliance. We focus on thorough documentation, precise coding, and data validation across various risk models like HCC, CMS, and ACA.
Specialties
Our risk adjustment team includes certified coders, clinical documentation experts, and data analysts. They work together to identify diagnosis gaps, validate coding accuracy, and ensure alignment with regulatory guidelines—supporting accurate risk scores and sustainable value-based care performance.
| Specialty | Setting |
|---|---|
| Certified Risk Coder | Works within payer and provider organizations ensuring HCC coding accuracy |
| Clinical Reviewer | Performs chart audits in outpatient and inpatient settings |
| Data Analyst | Analyzes risk score trends in health plans and accountable care organizations |
| Quality Auditor | Monitors compliance across Medicare Advantage and ACA programs |
Accurate and Compliant Risk Adjustment Services
We provide end-to-end risk adjustment services that support healthcare organizations in capturing accurate patient acuity and aligning with CMS, ACA, and HHS-HCC models. Our solutions include coding audits, chart reviews, and gap closure strategies to improve coding accuracy and minimize financial risk. With clinical and data-driven insights, we ensure better risk score accuracy, optimized reimbursements, and ongoing regulatory compliance in value-based payment environments.
Core Features of Our Risk Adjustment Services
Why Our Risk Adjustment Services Stand Out
We combine clinical, coding, and analytical expertise to help healthcare organizations manage risk efficiently. Our services ensure accurate patient data capture and regulatory compliance while maximizing reimbursement. Whether you’re a health plan or provider group, we tailor our approach to support your risk adjustment goals.
FAQ's
Risk adjustment is a method used to predict healthcare costs by accounting for patients’ health status and demographics, ensuring fair reimbursements in value-based care models.
Health plans, Medicare Advantage organizations, ACOs, and providers participating in risk-based contracts benefit from accurate risk adjustment support.
HCC (Hierarchical Condition Category) codes are used in risk adjustment models to predict future healthcare costs based on a patient's diagnoses and demographics.
We use certified coders, clinical reviewers, and proprietary audit tools to validate diagnoses, close gaps, and align documentation with regulatory standards.