Retrospective Coding
Annova’s retrospective coding services ensure accurate risk adjustment by thoroughly reviewing submitted claims and medical records across various HCC models, including Medicare Advantage (CMS-HCC), ACA (HHS-HCC), and Medicaid (State-Specific HCCs). Our expert coders validate submitted diagnosis codes, confirm alignment with clinical documentation, and suggest edits or deletions for unsupported or incorrect codes, reducing audit risks. Additionally, we identify missed chronic conditions that impact risk scores, ensuring all eligible HCCs are appropriately captured for maximum compliance and reimbursement accuracy. Leveraging AI-assisted coding tools and expert-driven chart reviews, Annova helps payers and providers refine risk scores, close documentation gaps, and enhance coding accuracy, ultimately improving financial and operational performance in risk-adjusted payment models.
Charts coded in one season
Certified Coders
Coding Accuracy
Comprehensive Services
Medicare HCC Coding
Annova Solutions offers industry-leading Medicare HCC (Hierarchical Condition Categories) coding services tailored to Medicare Advantage plans. Our focus is on accurately capturing risk-adjusting diagnoses to optimize risk scores and ensure compliance with CMS guidelines. By leveraging advanced coding methodologies, we address documentation gaps, improve coding specificity, and align with the financial complexity of patient care. Our Medicare HCC coding services prepare organizations for audits like RADV by ensuring complete and precise documentation, enabling better financial and care management outcomes.
Commercial HHS Coding
Our Commercial HHS coding services are designed to support ACA Health Insurance Exchange plans by aligning coding practices with the HHS-HCC model. We specialize in capturing accurate risk-adjusting diagnoses that reflect patient complexities, ensuring adherence to value-based care and risk adjustment requirements. By streamlining documentation and coding practices, we help healthcare organizations enhance compliance, reduce claim denials, and optimize reimbursements. Our expertise ensures a seamless integration of commercial coding processes into your risk adjustment strategies, strengthening your financial and operational performance.
Medicaid Coding
With expertise in Medicaid risk adjustment models, Annova Solutions delivers comprehensive coding solutions for Medicaid and Medi-Cal programs. Using the CDPS model, we ensure accurate diagnosis capture, addressing state-specific compliance requirements and improving population health management. Our Medicaid coding services focus on mitigating audit risks, enhancing documentation quality, and optimizing reimbursements to reflect the true complexity of care provided. By combining advanced coding practices with a focus on compliance, we empower Medicaid programs to drive sustainable financial outcomes and better care coordination.
Other Comprehensive Services
- Complete Code Capture (CCC), including Z-codes and SDOH for holistic documentation
- Retrospective Chart Reviews for accurate diagnosis validation and recapture
- Risk Adjustment Optimization through detailed coding validation processes
- Audit Preparedness and Documentation Support for RADV and other reviews
- Identification and Resolution of Documentation Gaps to improve compliance
Key Benefits
Optimized Risk Score Accuracy
Our retrospective coding process ensures accurate capture of chronic conditions and unreported diagnoses, directly improving RAF scores and risk adjustment outcomes for Medicare Advantage, ACA, and Medicaid plans.
Audit Readiness & Compliance
We proactively identify and correct documentation gaps, reducing the risk of RADV audits and financial penalties. Our compliance-driven approach aligns with CMS and HHS regulations to ensure accurate and defensible coding.
Financial Performance Enhancement
By recapturing eligible HCCs and validating previously submitted diagnoses, we help payers and providers optimize reimbursements while minimizing claim denials and revenue losses.
AI-Powered Quality Control
Our proprietary Quality Control (QC) Tool leverages AI and machine learning to standardize audit reviews, detect inconsistencies, and enhance coding accuracy, ensuring regulatory adherence and operational efficiency.
Scalable & Tailored Solutions
Whether addressing high-volume chart reviews or payer-specific coding needs, our retrospective coding services adapt to evolving regulations and operational demands, offering a seamless and customized approach for healthcare organizations.
Who We Serve
At Annova Solutions, we serve a diverse range of healthcare organizations, each with unique needs:
FAQs
Retrospective coding involves reviewing past medical records to ensure accurate diagnosis capture and proper risk adjustment. This process identifies documentation gaps, enhances data accuracy, and ensures compliance with regulatory standards, leading to optimized reimbursements and improved patient care.
Our services help healthcare organizations by ensuring precise coding, which leads to accurate risk adjustment, compliance with regulatory requirements, and optimized financial performance. By identifying and addressing documentation gaps, we enhance data quality and support better patient outcomes.
We specialize in Medicare HCC (Hierarchical Condition Categories), Commercial HHS (Health and Human Services), and Medicaid CDPS (Chronic Illness and Disability Payment System) coding models, ensuring comprehensive coverage across various payer requirements.
We employ certified coders supported by advanced Natural Language Processing (NLP) technology to meticulously review medical records. Our proprietary Quality Control (QC) system further enhances accuracy by identifying potential errors and ensuring adherence to the latest coding guidelines and regulatory standards.
Yes, our retrospective chart reviews are designed to prepare healthcare organizations for audits like the Risk Adjustment Data Validation (RADV) audit. We identify and document the "One Best Encounter" for each HCC category, ensuring robust support for each diagnosis and facilitating a smooth audit process.
Our Complete Code Capture (CCC) approach includes all relevant Z-codes, encompassing SDOH factors. By accurately documenting these determinants, we provide a holistic view of patient health, enabling tailored interventions and promoting health equity.
In addition to coding, we offer Clinical Documentation Improvement (CDI), regulatory compliance assistance, tailored reporting for risk stratification, and training programs on best practices in retrospective coding. These services are designed to enhance overall data quality and operational efficiency.