HCC Coding / Medicare Advantage Organization Services

HCC-Coding Services and 360° Performance Analysis

HCC-Coding Services help to complete submission to RAPS / EDPS well before the prescribed timeframes. We conduct proxy or mock Risk Adjustment Data Validation (RADV) audits on the lines of CMS-RADV Audit Contractors for determining vulnerabilities in real time audits and recommend measures to ensure compliance with applicable statutes.

This initiative helps Medicare Advantage Organizations (MAOs) keep tabs on their liabilities for penalties and sanctions which may arise out of real time audits. We also conduct 360° full performance analysis of:

• Panel-providers to ensure appropriate Clinical Documentation and Coding team performance for accuracy of coding process
• Communication channels between Clinicians and Coders for appropriateness of prescribed PQP
• Data Submissions Team to ensure that coding data are submitted to RAPS/EDPS in prescribed timelines
• Patient Encounters to see that follow-up of patients from plan happens as desired to enable the patients to stay healthy and stay subscribed with the plan
• We also offer 4-Star Rating and HEDIS Data Abstraction Services for entitlement of Quality Performance Bonus (QPB) by helping you get the star rating score of 4/4