You will get HCC Risk Adjustment Audit
Project details
HCC Risk Adjustment Coding Project involves a comprehensive retrospective review of medical records to ensure the accurate capture and reporting of chronic conditions that impact patient risk scores. The primary objective is to translate clinical documentation into specific ICD-10-CM codes that map to Hierarchical Condition Categories (HCCs), ensuring compliance with CMS or HHS risk adjustment models. This process is vital for reflecting the true disease burden of a patient population and securing appropriate reimbursement.
Core Project Scope:
Chart Abstraction: A systematic review of outpatient clinical documentation, including progress notes, consults, and discharge summaries, to identify all reportable chronic conditions.
M.E.A.T. Criteria Validation: Every assigned code must be supported by documentation proving the condition was Monitored, Evaluated, Assessed or Treated during the face-to-face encounter for the specific date of service.
Coding & Mapping: Assigning the highest level of specificity for ICD-10-CM codes and accurately mapping them to the relevant HCC version (e.g., V24 vs. V28).
Compliance: Adhering strictly to official Coding Guidelines and HIPAA regulations.
Core Project Scope:
Chart Abstraction: A systematic review of outpatient clinical documentation, including progress notes, consults, and discharge summaries, to identify all reportable chronic conditions.
M.E.A.T. Criteria Validation: Every assigned code must be supported by documentation proving the condition was Monitored, Evaluated, Assessed or Treated during the face-to-face encounter for the specific date of service.
Coding & Mapping: Assigning the highest level of specificity for ICD-10-CM codes and accurately mapping them to the relevant HCC version (e.g., V24 vs. V28).
Compliance: Adhering strictly to official Coding Guidelines and HIPAA regulations.
Project Type
OtherWhat's included
| Service Tiers |
Starter
$50
|
Standard
$90
|
Advanced
$180
|
|---|---|---|---|
| Delivery Time | 2 days | 3 days | 5 days |
Number of Revisions | 1 | 2 | 2 |
About Abhilash
HCC Risk Adjustment Specialist | ICD-10-CM | CPT | US Healthcare RCM
Warangal, India - 6:29 pm local time
I am a Certified Professional Coder (CPC) and registered pharmacist with hands‑on experience in Medicare Advantage (FFA) HCC coding for plans like Wellcare, CNC, Elevance, Prominence, Kaiser Permanente, American Health, Point32Health and UPMC (Level 2 and 3).
What I can do for you:
HCC / Risk Adjustment coding from provider documentation
ICD‑10‑CM diagnosis capture using MEAT criteria
Retrospective and prospective chart review
RAF score review and identification of missed chronic conditions
Denial analysis related to diagnosis coding and documentation gaps
Provider query support and documentation improvement suggestions
Highlights of my experience:
Worked on multiple Medicare Advantage plans (Retrospective project, FFS).
Familiar with ACO, ACA‑RA, Medicaid and other US healthcare programs.
Comfortable working with EHR/EMR systems and RCM workflows.
Tools and skills:
ICD‑10‑CM, CPT
HCC Risk Adjustment
US Healthcare RCM, Medical Billing & Coding, Denial Management, EHR/EMR
If you share a sample chart or small batch of records, I can complete a short test to demonstrate my accuracy, turnaround time and communication style before you commit to a larger project.
Steps for completing your project
After purchasing the project, send requirements so Abhilash can start the project.
Delivery time starts when Abhilash receives requirements from you.
Abhilash works on your project following the steps below.
Revisions may occur after the delivery date.
Chart review, validate MEAT, assign ICD-10 to HCC, internal QA audit.