Comprehensive Health Plan Services designed to support healthcare organizations through audits, chart collection, provider education, and program development—enhancing care quality, compliance, and operational efficiency.
Equip providers and staff with the latest HCC coding and documentation training to improve compliance, accuracy, and audit readiness.
Traditional retrieval methods ensure complete, HIPAA-compliant chart capture to support accurate coding and defend against audits.
Review past submissions to uncover errors, improve documentation, and strengthen audit defense while protecting revenue integrity.
Identify and correct documentation issues before submission, reducing compliance risk and ensuring accurate HCC capture.
Verify accuracy between clinical documentation, coding, and reported data to safeguard integrity across all systems.
Build a customized, compliant framework that aligns with CMS guidelines and scales to meet evolving regulatory requirements.
Develop internal leaders who can deliver ongoing education, reinforcing compliance culture and organizational expertise.
Deliver personalized one-on-one or group training tailored to clinicians, coders, and staff, with a focus on HCC coding accuracy and compliant documentation under CMS and OIG guidelines. Our sessions emphasize audit readiness, best practices for capturing chronic conditions, and reducing exposure to compliance risk. With continuous updates to reflect regulatory changes, we equip your teams to improve accuracy, safeguard revenue integrity, and strengthen audit defense.
We specialize in all retrieval methods, including deploying experienced teams onsite to collect patient charts and clinical records critical for risk adjustment and audit readiness. This hands-on approach ensures records are complete, accurate, and HIPAA-compliant, while reducing audit vulnerabilities and reinforcing the integrity of coding and compliance processes in today’s regulatory environment.
Conduct in-depth reviews of previously submitted charts to validate HCC coding accuracy and identify under- or over-reported diagnoses. Our retrospective audits are guided by CMS regulations, RADV audit requirements, and payer-specific guidelines, providing a roadmap for documentation improvement and resubmission where appropriate. Findings include actionable recommendations that not only protect against compliance risk but also enhance future coding accuracy and audit defense.
Implement proactive reviews across current patient encounters to identify and correct documentation or coding discrepancies before submission. Prospective audits reduce compliance risk by ensuring complete and accurate HCC capture, mitigating downstream exposure during RADV or payer audits. This forward-looking approach builds a culture of accuracy and accountability, protecting both reimbursement and organizational integrity.
Audit the fidelity of data as it moves from clinical documentation through EHRs, coding workflows, and submission platforms. Our validation process detects mismatches between provider notes, diagnosis codes, and what is ultimately reported, ensuring accuracy in the face of CMS data validation and payer audits. By establishing corrective workflows and control points, we help organizations protect against audit findings while reinforcing confidence in their risk adjustment submissions.
Design and implement a tailored end-to-end risk adjustment program that incorporates governance, workflow design, training, audit checkpoints, and performance metrics. Our programs are built to withstand regulatory scrutiny, aligning with CMS HCC updates, OIG recommendations, and payer guidelines. Whether standing up a new function or strengthening an existing one, we help organizations optimize capture of risk while reinforcing compliance and audit readiness.
Prepare internal champions—such as physician leaders, senior coders, and compliance officers—to deliver accurate, compliant, and engaging training. Our train-the-trainer model emphasizes advanced HCC coding principles, audit scenarios, and regulatory updates, enabling these leaders to cascade knowledge across the organization. This sustainable approach ensures consistency, reinforces compliance culture, and reduces dependency on external resources.
