HCC Risk Adjustment Coding

AE & Associates will help smooth the progress of HCC (Hierarchical Condition Categories) between IPAs/Medical Groups and Health Plans through an in-depth analysis in order to retrieve vital information that improves physician HCC coding, a key component under the CMS Risk Adjustment Model. AE’s solution, addresses the root of the cause of missing and incorrect HCC coding. We offer training for providers with a guarantee of > 95% rate in code accuracy, staff physician auditing the auditors and trained clinicians for optimizing member evaluations to Medicare Advantage guidelines.

HCC Coding Services

AE can extract all HCC codes to support Medicare Advantage plans in completing accurate risk assessment of their membership and submit complete and accurate data before CMS deadlines.

Retrospective Risk Adjustment

With CMS tightening risk adjustment payments to plans and now performing RADV Audits, what’s a reasonable approach to preparing for these audits while at the same time ensuring our Medicare Advantage Plan is receiving CMS payments?

Prospective Risk Adjustment

Although retrospective chart review ensures that health plans are capturing all HCC related diagnostic codes for members, it does not address the need to provide education and training to providers. At AE & Associates, we are unique, where can offer a staffed physician to educate physicians on documentation.

Prospective provides health plans the benefits of identifying, documenting and pre-selecting claims before they are reported to CMS.

RADV Audit Service

With the RADV pilot completed, CMS will continue to conduct RADV audits to determine whether differences in coding between MA plans and Fee-For-Service providers are the results of coding pattern or of underlying beneficiary health status.