Risk Adjustment Coding
Charts coded in one season
Certified Coders
Coding Accuracy
Our Comprehensive
Risk Adjustment Coding Services
At Annova Solutions, we deliver HIPAA-compliant risk adjustment solutions designed to enhance clinical documentation and coding practices. Our services help payers, providers, and ACOs improve outcomes for Medicare, Medicaid, and ACA members by ensuring accurate HCC coding, optimizing reimbursements, and supporting the development of better healthcare plans.
Concurrent & Prospective Reviews
We identify HCC gaps, verify claims data, and ensure accurate documentation during and before the care delivery phase. These reviews enable real-time interventions, prevent coding errors, and enhance risk score accuracy.
Retrospective Reviews
Our retrospective reviews analyze historical claims and medical records to uncover missed or undocumented HCCs. This ensures accurate reimbursements and compliance while identifying opportunities for continuous improvement.
Supporting Services
- HEDIS Abstraction
- Suspecting and AWV Support
- Data Analytics (Gap Analysis)
- Scope Definition
- Record Retrieval (Electronic and Manual)
- Pre-Visit Planning
- Provider Education & Member Engagement
- CDI & Provider Education
- Pre-Submission Check
- RADV Support
- Quality Control for HCC Coding
Key Benefits
Experienced and Highly Skilled Team
Annova Solutions employs a team of AAPC- and AHIMA-certified coders, ensuring precision in HCC coding and documentation accuracy. Our workforce consists of domain experts proficient in risk adjustment coding, leveraging cutting-edge tools and methodologies to enhance data integrity.
Advanced Quality Control Mechanisms
Our proprietary Quality Control (QC) Tool streamlines auditing and Level 2 (L2) review processes in HCC coding. By implementing standardized error classification, root cause analysis (RCA), and automated feedback loops, we ensure high coding accuracy and compliance across all risk adjustment workflows.
Compliance & Secure Infrastructure
With stringent HIPAA, SOC 2 Type II, and ISO 27001 security standards, our infrastructure ensures data confidentiality and regulatory adherence. Our dedicated operations floor, biometric access, and encrypted document handling guarantee end-to-end security in medical coding.
AI-Driven Accuracy & Efficiency
Predictive analytics, automation, and AI-driven workflow tracking improve coding precision while reducing audit risks. Our proprietary systems ensure real-time identification of coding gaps and streamlined documentation improvement strategies.
Scalable & Adaptive Solutions
We offer flexible, scalable HCC coding solutions tailored to the needs of payers, providers, and ACOs. Our services adapt to regulatory changes, evolving risk adjustment models, and the unique demands of healthcare organizations.
Who We Serve
At Annova Solutions, we serve a diverse range of healthcare organizations, each with unique needs:
FAQs
Capturing SDOH data enables healthcare organizations to assess non-clinical factors impacting health outcomes. By identifying barriers such as transportation, food insecurity, and housing instability, organizations can tailor care plans, reduce hospital readmissions, and improve patient engagement, leading to better clinical and financial performance.
SDOH data plays a crucial role in accurate risk stratification by identifying social risk factors that impact healthcare costs and utilization. By properly coding ICD-10 Z codes for social determinants, healthcare organizations can enhance risk adjustment models, secure appropriate reimbursements, and align with value-based payment structures.
Healthcare organizations must comply with CMS, NCQA, and state-level mandates that encourage the use of SDOH data for quality improvement and reimbursement. Proper documentation of Z codes, integration with EHR systems, and adherence to payer-specific reporting requirements are essential for meeting compliance and maximizing financial incentives.
By integrating SDOH data into care management workflows, providers can proactively address social risk factors and deploy targeted community-based interventions. Improved care coordination, patient navigation services, and resource allocation help reduce avoidable hospitalizations and improve long-term health outcomes.
Annova Solutions offers customized SDOH data capture, analytics, and EHR integration solutions to ensure seamless incorporation into clinical and administrative workflows. Our automated risk assessments, predictive analytics, and compliance-driven documentation support help organizations maximize quality metrics, reimbursement potential, and patient-centered care initiatives.