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Risk Adjustment Coding

We specialize in accurately capturing chronic conditions and patient severity through comprehensive HCC (Hierarchical Condition Category) coding, based on the CMS-HCC risk adjustment models. Our certified coders ensure precise documentation and coding of all relevant diagnoses to reflect true patient complexity. This approach supports accurate risk scores, drives appropriate risk-adjusted reimbursements for Medicare Advantage plans, and ensures full compliance with CMS guidelines—helping your organization remain audit-ready and financially sound.

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ACA Commercial Risk Adjustment Coding

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.

Frequently Asked Questions

1. What is HCC coding, and why is it important?

HCC coding captures chronic conditions and patient severity, ensuring accurate risk scores and proper reimbursements for Medicare Advantage and ACA plans.

2. How does Arovva Solutions ensure coding accuracy?

Our certified coders review medical records thoroughly, documenting all relevant conditions per CMS-HCC, HHS-HCC, and payer-specific guidelines.

3. What are the benefits of accurate HCC coding?

It improves risk scores, boosts reimbursements, ensures compliance, and reflects true patient complexity—keeping organizations audit-ready.

4. Do you support both Medicare Advantage and ACA plans?

Yes. We provide risk adjustment coding for both CMS-HCC and HHS-HCC models, helping enhance RAF scores and maintain compliance.