Our Services

Risk Adjustment

We are expertise in different types of risk adjustment models that are used to risk-adjust healthcare data such as HCC, HHS, CDPS, FCC etc…

Risk adjustment is a statistical process that considers the underlying health status and health spending of patients when examining their healthcare outcomes or healthcare costs. There are several types of risk adjustment models that are used to risk-adjust healthcare data such as HCC, HHS, CDPS, etc…

For Medicare Advantage, ACA, and Medicaid plans, accurate risk adjustment plays a critical role in the overall success of a health plan. Without a risk score that reflects actual member diagnoses, you will most likely miss out on reimbursements and may not be providing the best patient care that you can.

Although risk adjustment is designed to incentivize payers to accept patients who have more than one chronic condition in addition to those who are predominantly healthy, incomplete and inaccurate documentation and coding do not accurately represent relevant patient diagnoses, negatively affecting CMS premium payment, compliance, and patient care.

There are best practices to the process error-free as feasible, which results in creating accurate risk scores, the corresponding premium payment, while increasing patient care. These include correctly identifying code gaps, establishing experienced and knowledgeable staffing, performing deep and rigorous quality audits, and implementing the advanced process.

Service Overview

We offer a full-service HCC coding solution for all risk adjustment coding: ACA-Commercial, Medicare Advantage, and Managed Medicaid. Our compliance-based approach to medical record coding is delivered by AAPC or AHIMA certified coders who capture or suggest deletion of risk adjusting diagnostic codes and can also perform data validation audits. 

MDCS provides comprehensive, end-to-end prospective and retrospective risk adjustment services. We have deep subject-matter expertise to ensure risk-associated revenue is optimized while maintaining appropriate compliance. We provide full transparency at every stage, so you always know the status of your risk adjustment program.
Our team has hands on experience working on different types of Tools/Applications

Services in Risk Adjustment Space;

Front-end analytics services for suspecting of patient conditions
Prospective risk adjustment reviews
Retrospective risk adjustment reviews
Concurrent risk adjustment guidance
Risk adjustment educational programs (CMS-HCC, HHS-HCC, commercial exchange and Medicaid managed care)
Risk adjustment data validation (RADV)
NLP risk adjustment coding audit
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