We Analyse Revenue Impact of Prudency of HCC Coding / Clinical Documentation / HEDIS / Star Rating and RADV Audit Vulnerabilities in the Capitated Environment with the Following Objectives:

  • To determine the percentages of non-qualifying HCC-Codes derived from the claims, medical records, prospective assessments and provider assessment forms (PAFs) as per the qualifying standards of the CMS guidelines
  • To understand the impact of the above-mentioned deviations on your Coordinated Care (CC) Plans including MA plans (Both Part C and Part D- HCCs) as well the Medicaid
  • To assess appropriateness of claim coding practices to ascertain whether submitted diagnoses codes via claims are supported by prudent clinical documentation
  • Assessment of prudency of your medical record coding process (In-house coders or vendor’s coders if outsourced)
  • Assessing whether there is an accurate interpretation of clinical documentation found within the charts by the coders