Risk Adjustment & HCC Coding Services
MedCodex provides comprehensive risk adjustment coding to support Medicare Advantage plans, ACOs, and value-based care programs. Our HCC specialists ensure complete and accurate Hierarchical Condition Category (HCC) capture, RAF score optimization, and compliance with CMS risk adjustment data validation (RADV) requirements.
What We Do
- Prospective and retrospective HCC coding reviews
- RAF score calculation and gap analysis
- Chronic condition identification and closure
- RADV audit support and documentation improvement
- Annual wellness visit (AWV) coding support
- Care gap identification and reporting
HCC Model Expertise
We support both CMS-HCC (v24, v28) and HHS-HCC models used by Medicare Advantage plans and ACA marketplace payers. Our coders understand the hierarchical relationships between HCC categories and ensure that the most clinically specific codes are captured to reflect true patient complexity.
Prospective vs. Retrospective Reviews
Prospective Reviews: Conducted before or during the care year. Our coders review scheduled patient encounters and flag chronic conditions that should be addressed and documented at the visit, closing care gaps in real time.
Retrospective Reviews: Conducted after the service year. We review medical records to identify HCC conditions that were diagnosed and treated but not coded on submitted claims, supporting supplemental data submissions.
Compliance & RADV Readiness
CMS RADV audits can result in significant recoupment if HCC coding is not supported by medical record documentation. MedCodex ensures that every HCC code is fully documented and defensible, reducing your RADV risk and preparing your organization for audit.
Why HCC Accuracy Matters
Every uncaptured HCC represents lost revenue for health plans and risk-bearing providers. Studies show that the average Medicare Advantage member has 2–3 HCC conditions that go uncoded each year. Our thorough review process closes those gaps, improving RAF scores and ensuring your capitation payments accurately reflect your patient population's true health status.