RISK ADJUSTMENT  

Risk Adjustment Medical Coding Solutions

Risk adjustment isn’t just about coding—it’s about telling the complete patient story. At HealthSpective, we combine clinical expertise with advanced coding precision to ensure every diagnosis is accurately captured and fully supported.

• Certified, experienced risk adjustment coders

• Deep expertise in HCC and CMS guidelines

• Proactive compliance and audit readiness

• Transparent communication and reporting

• Scalable solutions tailored to your organization

Maximize the value of your risk adjustment programs with HealthSpective’s expert medical coding services. We help health plans, provider groups, and healthcare organizations capture the full clinical picture and acuity of their patient population—ensuring accurate reimbursement, audit readiness, and regulatory compliance.

 

Our Risk Adjustment Coding Services:

1. Prospective Coding (Pre-Encounter)

​Pre-visit reviews will identify opportunities providers may address during patient encounters.  We identify HCC codes due for re-evaluation, note potential conditions based on historical documentation, review reported coding for accurate specificity – all to improve RAF scores at the point of care.

2. Concurrent Coding (Point-of-Care Support)

Support real-time documentation and coding before finalizing the diagnosis coding and billing process.  This will ensure accuracy while reducing provider burden. Our team reviews medical records to identify missed or unsupported diagnoses, closing gaps and improving RAF scores.

3. HCC Coding & Validation

Our certified coding specialists ensure all Hierarchical Condition Categories (HCCs) are:

• Fully supported by clinical documentation

• Coded in compliance with CMS guidelines

• Optimized for accurate acuity and risk score capture

4. Audit & Compliance Support 

Stay audit-ready with confidence. HealthSpective provides:

• Internal coding audits

• Documentation improvement recommendations

• HHS-RADV and CMS audit preparation

• Error identification and correction strategies

5. Clinical Documentation Improvement (CDI) 

Strong documentation is the foundation of accurate coding. Our CDI experts work with your providers to:

• Improve specificity and completeness

• Align documentation with coding requirements

• Reduce query rates and audit risk

6. Advanced Reporting & Insights

Gain full visibility into your risk adjustment performance with:

• Coding accuracy reports

• RAF impact analysis

• Gap identification and closure tracking

• Ongoing performance dashboards