In the release of the Medicare Advantage Risk Adjustment Data Validation Final Rule by the US Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), insurers are accountable for the diagnosis reported to claim Medicare reimbursements.¹
Insurers, also known as ‘payers’, are now under tremendous pressure to ensure accurate risk adjustment factor (RAF) scores, of Medicare enrollees linked with their Medicare Advantage Organizations (MAOs), in order to withstand RADV audits and safeguard from penalties.
Outsourcing HCC Medical Coding Services is an emerging alternative solution for MA organizations to quickly get started with their Medicare enrollee’s chart review and audit tasks through certified Hierarchical Condition Category (HCC) coders who are updated with the latest technology and ICD-10-CM guidelines for coding and reporting.
However, selecting the right HCC Coding Service Provider can be daunting, especially when you have to meet the tight deadline for submitting risk adjustment (RA) data for use in risk score calculation runs for payment years 2023, and 2024.
In the article, we will focus on 3 steps to consider when looking for the right HCC Coding Service Provider in the United States (US).
How to choose the right HCC Medical Coding Service Provider?
Selecting an HCC Coding Service Provider can be challenging. However, considering the below steps when evaluating to Outsource HCC Medical Coding Services, will make it simpler.
Outsource HCC Medical Coding Service to RA Technology Solutions Provider
HCC Risk Adjustment Coding will need certified coders to perform Medicare Advantage (MA) enrollee’s chart review and audit tasks.
This is where, a RA technology solution provider can be an ideal choice to consider for outsourcing your MA organization’s medical coding services, including first-level and second-level chart audit tasks, as it usually accommodates experienced HCC coders who have worked on building risk adjustment solutions.
In addition, an HCC Risk Adjustment Coding Solutions Company will eliminate the cost and hassle of hiring, training, and managing HCC coders. You can quickly connect and get started with experts from the same field. This can be helpful for any-sized MA organization that is looking for an HCC Coding Services Company to match tight deadline situations.
Select an HCC Risk Adjustment Coding Service Provider that offers AI-based Solutions
Next, AI-based Risk Adjustment (RA) technology solution is the latest buzzword in the healthcare industry, as the usage of AI in the healthcare market is forecast to reach around $188 billion by 2030.²
An AI-based Risk Adjustment Solution Provider that provides HCC Coding services too will be of great help as you’ll be able to partner with an HCC Solution Provider whose technology solutions are being tried, tested, and accepted by MA organizations to perform accurate risk adjustment factor scores derivation for Medicare enrollees.
Outsource to an HCC Coding Service Provider with a presence in the US
To ensure accurate HCC documentation, every Medicare enrollee’s diagnosis condition documentation must indicate the qualified healthcare provider’s assessment and/or plan for the management of the condition.³ Therefore, as a healthcare payer you may have to connect with the concerned healthcare providers in order to justify patient encounters. This can call for a visit to the healthcare location in person.
Outsourcing your HCC Coding Service to an HCC Coding Solution Provider with a presence in the United States (US) can release you from the hassle of arranging a visit to adhere to the MEAT or TAMPER™ criteria. This is how outsourcing your Risk Adjustment HCC Coding Services to a provider in the US will help you fill the gap by performing the task on your behalf.
Looking for an HCC Coding Solution Provider in the US to affirm delivery of your existing HCC Coding Service requirements with stringent deadlines?
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Click to get more information about MA RADV Final Rule.