Risk Adjustment
Clinical complexity is there.
Make sure the record says so.
A member's RAF score determines payment, but it is driven entirely by what was documented, coded, and submitted. Most organizations leave meaningful RAF on the table not because the conditions aren't there, but because the documentation doesn't reflect them.
The Challenge
The gap between clinical reality and documented risk is rarely about coding knowledge.
It is about workflow gaps that let conditions fall through, the patient whose CKD Stage 3 is in every specialist note but never coded on the PCP claim. The diabetic patient whose peripheral neuropathy is treated at every visit but doesn't appear in a claim. The member with severe COPD documented as "shortness of breath."
We find those gaps systematically, and design the operational changes that close them durably, not just for this measurement year.
HCC Analytics
Member-level RAF analysis, documentation opportunity scoring, predictive gap identification, and performance dashboards that show you exactly where the gap is and which providers are driving it.
Prospective Programs
Pre-visit gap identification, AWV workflow design, and point-of-care provider alerts that capture conditions before the encounter closes.
Retrospective Review
Chart-to-claim audits that identify and correct documentation patterns across provider, site, and specialty, with education that prevents recurrence.
RADV Preparation
Pre-audit sampling, documentation remediation, and defense strategy for organizations facing CMS Risk Adjustment Data Validation review.
Coding Accuracy
Coding quality audits, ICD-10 specificity review, and certified coder training tailored to your patient population and payer mix.
HCC Analytics
You can't close gaps you haven't located precisely.
Most organizations know their aggregate RAF is below where it should be. Fewer know which specific conditions are being missed, by which providers, across which member segments. That precision is what makes a program fixable rather than just frustrating.
Our HCC Analytics practice combines claims data, clinical record analysis, and predictive modeling to produce a clear, actionable picture of your documentation gap at the member and provider level.
- Member-level RAF trending and gap scoring
- Provider and site-level documentation opportunity analysis
- Predictive HCC gap identification before the measurement year closes
- Payer mix and RAF benchmarking against peer organizations
- RADV sampling analytics and audit risk stratification
- Custom performance dashboards for program management
What the analytics surface
What to Expect
A phased approach that builds program durability.
Baseline Assessment
RAF benchmarking against plan average and peer groups. Chart-to-claim gap analysis. Documentation pattern review by provider and specialty.
Program Design
Prospective workflow design, AWV scheduling, pre-visit planning, coder-clinician query protocols. Retrospective audit scope and prioritization.
Implementation
Hands-on program launch with your team. Provider education. EHR integration where available. Ongoing coding review and feedback loops.
Performance Management
Monthly RAF trending. Program yield analysis. RADV risk monitoring. Year-over-year benchmarking to demonstrate sustainable capture.
Let's look at your RAF gap together.
We'll benchmark your current documentation patterns and identify where the program should start.