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Risk Adjustment / HCC

Program Services

Managing cyclical Risk Adjustment coding requirements can be a challenge for payors that results in the need for an “Army of Coders” some of the time, and not others. TrueRCM offers the advantage of expertise and experience, combined with automated workflow and data capture solutions that leverage Artificial Intelligence to significantly reduce human labor requirements. At the same time, we improve Risk Adjustment coding accuracy to provide you with a strategically better way forward to increasing plan member reimbursements while leaving the “Army of Coders” behind.

TrueRCM’s RISK ADJUSTMENT services for Medicare/Medicaid/Commercial health plans:

Coding or Data extraction from Medical Records and other data sources
  • Risk Adjustment/HCC Coding.
  • Clinical data extraction for HEDIS and ACO’s Measures
  • MIPS data extraction for physicians and group practices
Customized Predictive Analytics for Payers
  • Risk/Cost predictions
  • Diagnoses analytics
  • Procedure analytics
  • Drug analytics
  • Population Health analytics
  • Provider Performance analytics

TrueRCM’s approach leverages an integrated workflow that merges Artificial Intelligence processing capabilities and data capture with human design and quality oversight. Our systems are designed, and our people trained by a management team with decades of coding experience and over 10 years of experience in Risk Adjustment Coding. Further all of our coding personnel meet the following minimum experience requirements:

  • CPC/CRC /CCS certified coders
  • Coders with extensive clinical knowledge and comprehensive training on CMS RADV guidelines
  • An additional minimum of 3 years’ experience in Risk Adjustment coding

Our approach quickly solves the problem of a lack of certified coders to perform quality checks and lack of scientific approach that leads to poor quality of Risk Adjustment coding and loss of revenue

At the heart of TrueRCM’s Risk Adjustment service is our powerful, self-learning Artificial Intelligence engine, which is fully integrated to our automated machine-human workflow.

Our system enables us to ingest and fully inspect thousands of pages of charts and records in seconds, while isolating and capturing all required data and ICD 10codes. Then after our human QA review, the system correlates and automatically formats all outputs for submission. This includes the highly accurate and automated capture and analysis of (records):

File Name Accurately assigns ICD-10 codes for all discovered diagnosis
Patient Name Correlates and gathers member, provider, and DOS data with ICD-10 codes
Date of Birth Inbuilt TAMPER mapping for each diagnosis ensures accurate submission for Payments
Provider Name The system does not code a diagnosis if there is no documentation – Rather it flags incomplete provider documentations and routes it for inquiry
Provider Credentials
Facility / Point of Service
Dates of Service
Clinical Evidences to extract disease, disorder, injury, severity, anatomical site, laterality, onset and comorbidities among other factors.

TrueRCM’s processes and Artificial Intelligence technologies are secured end-to-end and are HIPAA and HL7 standards compliant.

TrueRCM’s experts leverage the unique analytical capabilities of our Artificial Intelligence solution for Risk Adjustment Code extraction and reporting. Analytics and reporting provided by TrueRCM provide actionable information related to performance visibility and areas for improvement, including the following examples:

  • Provider analytics on missed opportunities
  • Provider education reports and flags for missing documentation used to support Clinical Document Improvements

Analytics and reporting to identify Patient analytics related to Chronic conditions that can be used for subsequent year processing and reporting

TrueRCM’s Risk Adjustment coding support services, combined with our technology driven workflows can not only improve your plans’ direct financial results, but also reduce your overhead costs for coding, CMS reporting and compliance by up to 90%.

Increase Average Plan Member Reimbursement TrueRCM’s Risk Adjustment Coding support solution enables payors to gain significant advantages by improving financial performance.

Key benefits include, but are not limited to:

  • Ensure 100% error free RADV audits
  • Quick Turnaround time for submission, chart review time reduced by 70%
  • Realize higher revenues by accurately capturing new diagnoses codes
  • Realize higher revenues by accurately capturing diagnosis codes higher in the hierarchy

To learn more, contact TrueRCM today.

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