RISK ADJUSTMENT & CODING INTEGRITY

Protect revenue, ensure compliance, and optimize risk adjustment accuracy.

 

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 with clinical backgrounds

• Deep expertise in HCC and CMS guidelines

• Proactive compliance and audit readiness

• Transparent communication and reporting

• Scalable solutions tailored to your organization

​

OUR RISK ADJUSTMENT CODING SERVICES

• Prospective Risk Adjustment Audits (Mock RADV)

  • We conduct mock RADV audits to proactively identify documentation and coding gaps, strengthen provider education, and improve risk score accuracy before official reviews.

• CMS RADV Audit Support

  • Our team provides comprehensive audit readiness and execution support aligned with CMS RADV requirements—helping ensure defensible documentation, accurate submissions, and reduced financial exposure.

• CMS Star Rating Coding Verification (CPT II & HCPCS)

  • We validate CPT II and HCPCS coding tied to HEDIS measures to improve Star Ratings performance, focusing on accuracy, completeness, and alignment with quality reporting standards.

• Continuous Monitoring (Risk & Coding Focused)

  • HealthSpective offers ongoing monitoring programs to detect coding inconsistencies, identify risk trends, and maintain continuous compliance throughout the year—not just during audit cycles.

​

Maximize Accuracy. Minimize Risk. Strengthen Performance.

HealthSpective’s expert medical coding services 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.

​

Contact us today to elevate your risk adjustment and audit strategy.