AAPC - Advancing the Business of Healthcare

Risk Adjustment Solutions

Maximize your risk adjustment accuracy and meet your revenue goals.
Did you know? Every year, we audit more than 300K medical records across 40+ specialties — and maintain a 98% accuracy rate.

How AAPC Can Help Your Organization

We specialize in surfacing opportunities for better risk adjustment program performance. And we’re committed to ensuring you receive equitable compensation for the health conditions, health status, and demographics of your beneficiaries.

More Benefits

Prospective Risk Adjustment Chart Auditing

Our certified auditors and medical coders will identify gaps in care, assessment, and clinical documentation. And we equip your physicians for optimal patient monitoring and point-of care decisions, informed of chronic conditions, and suspected HCCs.

Retrospective Risk Adjustment Chart Auditing

Raise your risk-adjusted revenue and reduce your CMS RADV audit risk with our flexible services, ranging from focused audits for target populations and specific HCCs to end-of-year sweeps. Our experienced teams review patient encounter data in clinical documentation to identify diagnoses and conditions missing from original claims.

Concurrent Risk Adjustment Chart Auditing

Trim the intensity, cost, and error potential of annual sweeps by ensuring HCCs are captured correctly on encounter claims. Our RA team reviews for under-documented risk opportunities and verifies that all codes and conditions are accurate and supported by proper documentation. Missed diagnosis codes are then updated within the workflow, prior to claim submission.

Trial-Run RADV Audit Services

Mitigate your Risk Adjustment Data Validation (RADV) audit risks when our risk adjustment teams outline your substantiated HCCs, unsubstantiated HCCs, and unreported HCCs and equip you with actionable items to secure your compliance and safeguard your risk-adjusted revenue.

Initial Validation Audit (IVA) Services

Our IVA teams have the data validation expertise to lead you through the IVA process. We’ll complete your risk adjustment IVA on time and in compliance with HHS's requirements for validation of member demographic and enrollment data, medical claims data, and health status data.

Provider Engagement & Risk Adjustment Education

Our Provider Engagement and Risk Adjustment Education programs bridge the gap between your health plan and your providers. While nurturing engagement and partnership, we make sure your providers have the training and support needed to implement RA best practices. And we help establish processes to tract suspects, follow through with patient outreach, and optimize documentation and coding.

HCC Coding

Your health plan can rely on us to capture severity levels and secondary manifestations as we have extensive experience extracting diagnoses that substantiate disease and comorbid condition data. You can also count on us to perform quality assurance of all coding results to ensure your submission to CMS is accurate, optimal, and compliant.

Advantages of Our Risk Adjustment Solutions

We offer a full catalog of risk adjustment solutions, customized to meet the needs of small physician practices, a mid-size health plans, and multi-hospital health systems. Our teams specialize in risk methodologies, such as:

  • CMS-HCC Model

  • DxCG Model

  • Medicare and Medicaid CDPS Model

  • HHS HCC Model

  • ACO Model

  • ESDR Model

  • PACE Model

  • Hybrid Risk Models

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You're In Good Company

  • University Health
  • Bon Secour
  • Atlantic Health Systems
  • American Medical Association
  • Dedi Clinic
  • Anesthesia Business Consultants

Capture your risk burdens and improve your risk score accuracy.