Risk Adjustment & HCC Audits

Risk Adjustment & HCC Audits are designed to help you capture patient complexity accurately while standing on solid documentation. We review reported Hierarchical Condition Categories (HCCs) against the clinical record, confirming that each diagnosis is clearly supported, current, and documented at the right level of specificity. At the same time, we look for clinically supported conditions that were not coded at all-quiet missed opportunities that affect risk scores and revenue integrity.

Our HCC Documentation Verification service focuses on a defined set of encounters, typically for high‑risk or value‑based populations. For each chart, we identify supported HCCs, unsupported or questionable diagnoses, and potential additional conditions that are present, monitored, or treated but not reflected on the claim. The result is a balanced picture: where documentation is strong, where clarification is needed, and where chronic conditions need more consistent capture.

You receive clear summaries, provider‑friendly scorecards, and written recommendations that link risk adjustment coding directly to what is written in the note. We explain not only which diagnoses to re‑evaluate, but also which documentation elements-assessment language, linkage to manifestations, status of chronic conditions-will make future encounters audit‑ready.

These Risk Adjustment & HCC Audits are especially valuable for physician practices and outpatient groups participating in Medicare Advantage or other risk‑based arrangements. By aligning diagnosis coding with clinical reality, you reduce the likelihood of recoupments while supporting appropriate reimbursement for the populations you manage. Each engagement is conducted by an experienced risk adjustment auditor who keeps the emphasis on education, so providers understand how their everyday documentation decisions influence long‑term program performance and compliance.