We support accurate and compliant risk adjustment coding for Affordable Care Act (ACA) exchange-based plans by capturing all eligible diagnoses that impact a member’s Risk Adjustment Factor (RAF) score. Our certified coders conduct thorough medical record reviews and detailed abstraction to identify and document all relevant chronic and high-impact conditions. By aligning with HHS-HCC risk models and payer-specific requirements, we help health plans enhance RAF scores, ensure appropriate premium transfers, and maintain compliance with regulatory standards—ultimately supporting both financial performance and care quality.
They cover accurate coding for diagnostic imaging (X-rays, MRIs, CTs, ultrasounds) and interventional procedures like biopsies and vascular interventions.
Our expert coders review each report and apply the latest CPT®, ICD-10-CM, and HCPCS codes for both professional and technical components.
It ensures payer-specific requirements are met, reduces denials, and keeps your organization audit-ready.
They experience optimized charge capture, improved reimbursement, fewer denials, and better departmental efficiency.
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