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ABOUT OUR PROCESS:

Our team of Registered Nurses and Certified Coders are experienced and well versed in the Risk Adjustment process. We provide retrospective review of your medical records for submission as well as prospective chart analysis. Our strength lies in our expertise for communicating to the treating Physician the areas of record where documentation fails to support a valid Risk Adjusted code. We know how to partner with providers effectively to improve their documentation in order to support ICD-9 Code assignment. We focus attention on specificity of code, resulting in an accurate Hierarchical Condition Category (HCC) assignment, which allows for accurate Risk Score calculation. During our chart reviews, all documentation is evaluated for CMS and RX HCCs.
We conduct reviews year round and focus on the Primary Care Physician’s documentation. However, to provide an accurate assessment of the patient’s overall health conditions, we incorporate some Specialist records in the review to supply the Clinicians an accurate assessment of patient health status. Our team tracks and communicates chronic clinical conditions yearly to ensure year-to-year validation.