HCC Medical Coding
HCC Medical Coding Services
Best Risk Adjustment Solutions. Ensure Accurate Reimbursement, Unwavering Compliance.
HCC medical coding services are a necessity for value-based care providers. Our expert risk adjustment coders fulfill the documentation needs of every specialty by assigning diagnosis codes that facilitate accurate RAF scores for submission to payers.
- Providers receive appropriate capitated payments.
- Patient complexity is accurately documented.
- Payers accept risk adjustment data without rejection.
How does AIE Medical Management help?
HCC Medical Coding Analysis
HCC medical coding (Hierarchical Condition Category) is a risk-adjustment model designed by CMS. It estimates future healthcare costs based on patient age, gender, and health status.
RAF Score Calculation
Unlike fee-for-service, HCC coding focuses on patient complexity. Diagnoses are grouped into categories (HCCs) that carry a specific weight. These weights contribute to a patient’s Risk Adjustment Factor (RAF) score.
Clinical Documentation Accuracy
A higher RAF score indicates a patient with complex conditions requiring more resources. Accurate coding is the linchpin of financial stability for organizations managing Medicare Advantage and ACOs.
Why Choose AIE Medical Management for HCC Medical Coding?
Accurate RAF scoring has become a necessity, particularly since value-based care models determine payment based on patient complexity.
At AIE Medical Management, our certified coders analyze medical records to assign the proper standardized codes. This risk adjustment expertise ensures your RAF scores reflect the true illness burden of the patient. No more receiving insufficient funds or misallocating resources because of under-coding.
We follow the latest CMS guidelines and legislation so your claims comply. This protects you from audit risks and penalties found in RADV audits. With AIE, your revenue integrity will be timely and accurate.
Our rigorous training gives our coders an edge. They identify the right codes for even the most complex cases. This clinical coding solution helps avoid the documentation gaps that lead to revenue loss.
Put AIE’s HCC coding services to work for your practice. Our solutions bring speedy and correct reimbursements in today’s climate of growing regulations.
Try our affordable risk adjustment service that pays for itself...
Our medical coding and auditing recovers revenue that you’re currently missing. The increased reimbursement will more than cover our reasonable fees.
- Certified Risk Adjustment Coder
- Ongoing audits
- Detailed reporting
- Rapid turnaround
Unlock revenue via Retrospective Chart Reviews
AIE Medical Management’s coding service relies on specialized software that scans historical patient data. Our medical coders then review the records to identify "gaps in care"—chronic conditions that were previously documented but not recaptured. This audit results in highly accurate coding that ensures no revenue is left on the table for care already provided.
Prospective & Concurrent Reviews Service
Proactivity is the key to compliance. Our team reviews upcoming appointments or currently open charts. We alert providers about suspected conditions that need evaluation. This "pre-visit" planning empowers physicians to address chronic issues during the patient encounter.
MEAT Criteria Validation Service
To support an HCC code, the documentation must show that the condition was Monitored, Evaluated, Assessed, or Treated (MEAT). Our certified coders rigorously check every diagnosis against MEAT criteria to ensure it will stand up to a CMS audit.
Clinical Documentation Improvement (CDI) Service
We provide feedback loops to your physicians. If a provider consistently documents "Chronic Kidney Disease" without specifying the stage, our team flags this for education. This leads to more precise documentation over time.
Hire Certified Risk Adjustment Coders (CRC)
AIE Medical Management experts analyze patient records and assign diagnosis codes with precision. This CRC coding helps healthcare providers receive proper reimbursement from insurance companies.
Our skilled coding managers thoroughly review all charts to ensure compliance with CMS HCC models and interaction terms. You can trust AIE to capture every diagnosis with the right codes for optimal revenue cycle management.
Custom coding solutions for every healthcare facility
Risk adjustment is the key to payment and compliance, but not all facilities code the same. Whether you need retrospective reviews or concurrent analysis, AIE has dedicated coding experts for every medical domain. We match knowledgeable coders and auditors to handle your unique caseload. For HCC coding done right, our custom solutions make all the difference.
Get risk adjustment done right with our proven process
Our certified coders know how to ethically optimize documentation, uncover billable codes, and capture every dollar you’ve earned from payers. Here’s our systematic approach to represent patient diagnosis documentation within the codes:
Data Ingestion
Establishes secure connections (HL7/API) with your EHR or obtains chart exports via secure SFTP.
AI & Human Review
Processes charts to identify potential HCC medical coding opportunities.
Assignment
Certified coders review documentation to verify medical necessity and MEAT criteria.
Query Generation
Creates non-intrusive queries for providers to clarify the diagnosis if documentation is ambiguous.
Submission
Prepares validated codes for submission to payers or CMS.
Reporting
Ensures you receive detailed monthly reports on RAF score trends, coding accuracy, and financial impact.
Are You Frustrated with The "Reset" Challenge?
AIE Medical Management provides complete risk adjustment solutions. It is crucial to remember that CMS HCC models require diagnoses to be captured every single year. A condition coded in 2024 does not automatically carry over. Our experts ensure your team maintains this annual consistency. Don’t let medical coding problems affect your bottom line; our experts will detect and correct them before they damage your practice.
AIE Coding Audits & Consultancy Solutions
For healthcare leaders seeking truth in numbers, our medical coding services deliver. We scrutinize records to derive meaning, value, and direction.
Physician Burnout
Doctors are overwhelmed by administrative alerts and complex coding requirements. We handle the coding backend, allowing physicians to focus on patient care rather than code selection.
Data Silos
Information is scattered across specialists, labs, and hospitals, leading to missed diagnoses. We consolidate data from disparate sources to ensure a comprehensive view of the patient's health history.
Staffing Shortages
Finding experienced risk adjustment coders is difficult and expensive. AIE Medical Management acts as an extension of your team, providing scalable staffing without the overhead.
Let's transform your medical records into fair revenue...
Our dedicated medical coding experts efficiently extract insights from patient data to maximize your reimbursements.
- Skilled Coders
- OIG Alignment
- Improved Cash Flow
- Reduced Denials
Frequently Asked Questions (FAQs)
What is the difference between HCC coding and standard CPT coding?
Standard CPT coding describes what you did (procedures, visits), while HCC medical coding describes why you did it and how sick the patient is. CPT determines immediate fee-for-service payment; HCC determines the patient’s risk score and future capitated payments.
How often does the CMS HCC model change?
CMS updates the model annually. This can include changes to the weight of specific codes, the addition or removal of diagnosis categories, and adjustments to the normalization factor. AIE Medical Management stays ahead of these changes so you don’t have to.
Can you help with commercial risk adjustment?
Yes. While the CMS HCC model is the most common, many commercial payers and ACA exchanges use the HHS-HCC model. We support both, ensuring accuracy regardless of the payer mix.
What is the "interaction effect" in risk adjustment?
In the HCC model, certain combinations of diseases (e.g., Diabetes + CHF) increase the risk score more than the sum of the individual conditions. Our coders are trained to recognize and capture these interactions to ensure the RAF score is precise.
Let's transform your medical records into fair revenue...
Our dedicated medical coding experts efficiently extract insights from patient data to maximize your reimbursements.
- Skilled Coders
- OIG Alignment
- Improved Cash Flow
- Reduced Denials
