HCC Coding Compliance Auditing Solution

Ensure compliance and pass RADV audits with NLP technology

Technology to withstand RADV audits

ICD-10-CM & Coding Compliance Solutions

Coding compliance is an essential aspect considered when claiming for value-based care reimbursements. To eliminate under-coding or even worst, selecting the wrong ICD-10-CM and HCC codes leading to overclaiming, healthcare payors, risk adjustment vendors, and medical coding companies must perform medical chart auditing. These audits can be daunting, but with a MEAT-enabled HCC coding solution, medical coders can streamline the process of HCC code audit and increase their chances of success. MEAT stands for Monitoring, Evaluation, Assessment, and Treatment – four key elements that are critical in creating accurate and complete documentation of patient conditions.

By implementing this approach to coding compliance, healthcare organizations can reduce errors and omissions that could lead to claim denials or underpayments.

It is suggested to perform a first-level chart review and second-level chart review to compare claims data against other sources to identify discrepancies and correct any errors before submission. With the right tools in place, such as automated HCC code audit feature, organizations can quickly identify issues with their coding practices and take corrective action.

Overall, by investing in a comprehensive risk adjustment data validation solution that incorporates MEAT-enabled HCC coding principles along with robust claim comparison capabilities will help value-based care (VBC) organizations achieve optimal results and withstand RADV audits while improving overall financial performance over time.

HCC COMPASS

World's First Personalized AI-Powered Risk Adjustment Coding & Audit Platform

Key Benefits

Increase Coding Compliance

Code with confidence as a complete audit trail that supports MEAT criteria & evidence

Capture HCCs Looking Both Ways

Auto suggested ADDS "New HCC codes" and DELETES "Undocumented HCC codes" along with MEAT Criteria

Enhance Coding Efficiency & ROI

Consolidated view of all records with Auto Code Suggestions to perform chart review in less than 3 clicks

Key Features of HCC COMPASS

Automate HCC ADDS & DELETES

Add risk adjustment eligible diagnoses or delete diagnosis codes previously reported for VBC plan enrollees.

HCC codes
radv audits

3 click chart review for risk adjustment data validation

CMS-HCC RADV risk adjustment solution for medical coders to perform VBC claim data audit and comparison in three clicks.

NLP-powered Integrated ICD-10-CM and HCC Codebooks

Streamline VBC risk adjustment audits, reduce errors, and minimize the risk of regulatory penalties.

icd 10 codes

Make the Most out of RAAPID’s AI Risk Adjustment Technology

> 0
Years of Healthcare & AI Experience
> 0
Healthcare Clients Served
> 0 X
Return On Investment
> 0 %
Increased Efficiency And Productivity
> 0 %
Complete, Defensible Risk Scores
> 0 %
Reimbursement Accuracy

Data Use Security Measures

Security | Compliance | Platform Partners

SOC 2 TYPE 2

SOC 2® Type 2

Allows a peace of mind to clients who can trust that their valuable information is safe from cyber-attacks or other forms of misuse.

HIPAA Compliant

PHI

Ensures the confidentiality, integrity, and availability of protected health information (PHI).

AWS

Platform Partners

Protecting patient health information (PHI) by providing advanced security measures underpinned by strict compliance standards.

How HCC COMPASS Works

HCC COMPASS Works
HCC COMPASS Works

Client Testimonials

FAQs related to coding compliance solution

It helps in identifying potential errors or discrepancies in the documentation of diagnoses, which could result in an incorrect HCC RAF score. These errors can occur due to various reasons such as incomplete documentation, coding inaccuracies, and insufficient clinical evidence.

Implementing HCC coding compliance solution can help healthcare organizations identify these errors and take corrective actions to ensure an appropriate HCC RAF score. This solution typically involve analyzing claims data, medical records, and other relevant documents to validate the accuracy of the documented diagnoses.

Risk adjustment is a crucial aspect of healthcare, and it’s essential to ensure that health plans, medical coding companies, and risk adjustment vendors are doing their best in this regard. However, without proper validation audits in place, there may be errors or inaccuracies in the data used for risk adjustment calculations.

This is where a risk adjustment data validation audit solution comes into play. By implementing such a solution, organizations can validate their data sources and ensure that they comply with industry standards. This not only helps improve the accuracy of risk adjustment calculations but also promotes transparency and trust between all parties involved.

Moreover, utilizing an automated solution eliminates manual processes that could be prone to human error while saving time and reducing costs significantly. As healthcare providers seek ways to enhance patient outcomes continuously, implementing a risk adjustment data validation audit solution should remain top priority as it ensures accurate reimbursement for services rendered while mitigating fraud/abuse risks associated with payment systems.

Healthcare organizations face the challenge of ensuring the accuracy and completeness of their medical claims data. This is where an NLP-powered medical chart audit solution comes into play. It helps healthcare providers to complete claim comparison and HCC code audit tasks with ease.

The solution uses natural language processing (NLP) algorithms to analyze medical records, identify any possible errors or discrepancies in coding, and provide recommendations for corrective action. By automating these processes, it saves time and enables healthcare organizations to focus on providing quality care.

Medical chart auditing process is essential for value-based care organizations as they help ensure that the information submitted matches what was actually done during patient visits. With accurate coding in place, health plans can ensure appropriate payments based on their members’ needs

MEAT-enabled risk adjustment solution is a game-changer for HCC claim reviewers and auditors. This innovative technology allows them to easily identify any gaps or errors in the coding of patient data, ensuring that the correct level of risk adjustment is applied to each patient’s case. The MEAT criteria stands for “Monitoring, Evaluating, Addressing, and Treating,” which are all critical components of effective HCC claim review and auditing.

With MEAT-enabled risk adjustment solutions at their disposal, HCC claim reviewers and auditors can quickly detect discrepancies between reported diagnoses and actual medical conditions. By identifying these inconsistencies early on in the process, they can take appropriate action to ensure that patients receive accurate care while minimizing waste and fraud.

When it comes to selecting the best medical chart compliance audit tool, there are several factors that need to be considered. Primarily, it is important to ensure that the solution complies with Centers for Medicare & Medical Services (CMS) regulations and guidelines.

The audit solution should also have robust data analysis capabilities to identify potential issues in coding and documentation.

Contact us to get started.

Help us to know you better!

This field is for validation purposes and should be left unchanged.