Risk Adjustment Coding
Pro1 Health is a trusted leader in Healthcare Revenue Cycle Management (RCM) and Risk Adjustment Solutions. By combining advanced technology with the expertise of our global team of 3,000 professionals, we streamline the complexities of RCM—enabling healthcare providers to prioritize exceptional patient care while achieving their financial and operational objectives.
Our strong commitment to innovation, security, and scalability has established us as a valued partner for healthcare organizations. With proven expertise and a future-focused approach, we deliver end-to-end solutions across the revenue cycle and risk adjustment spectrum, empowering providers to thrive in an evolving healthcare landscape.
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Maximize Reimbursement Accuracy with Comprehensive HCC Coding Solutions
At Pro1 Health, we deliver end-to-end risk adjustment coding services designed to support Medicare Advantage, Medicaid managed care, and Commercial ACA plans. Our certified coding team ensures accurate and compliant capture of Hierarchical Condition Categories (HCCs), helping improve RAF scores while maintaining strong data integrity and audit readiness.We support major risk adjustment models, including CMS-HCC, HHS-HCC, and ESRD, to meet diverse payer and regulatory requirements.
Retrospective Coding
Retrospective chart reviews help identify and capture missed diagnoses that impact risk scores and reimbursement accuracy.
Our coders
Review complete medical records, including paper charts, EHR data, and scanned documents- Abstract diagnosis codes in alignment with official documentation guidelines (MEAT/TAMPER)
- Ensure capture of chronic conditions and relevant suspect codes
- Identify documentation gaps for CDI intervention and provider education
- Maintain audit trails for RADV and internal quality assurance validation
Prospective Coding
We help you stay ahead by performing real-time reviews to identify and close documentation gaps before or during patient encounters.
Our process includes
- Reviewing problem lists, prior-year codes, and suspect diagnosis indicators
- Preparing pre-visit HCC summaries for providers
- Recommending compliant documentation queries to improve clinical detail
- Collaborating with clinical teams to support accurate capture at the point of care
Concurrent Coding
For hospital inpatient and transitional care settings, our concurrent coding services support real-time clinical documentation review during the course of patient care.
Our Service Delivers
- Timely HCC capture during active treatment episodes
- Reduction of missed or undocumented conditions prior to discharge
- Real-time coding support aligned with discharge planning workflows
Deliver Excellence in Risk Adjustment Coding
1. Comprehensive Chart Review
Detailed review of patient medical records to ensure accurate capture and coding of all relevant diagnoses.
2. Accuracy in HCC Coding
Specialized HCC coding expertise to accurately reflect patient health status and support proper risk adjustment outcomes.
3. Global Delivery Team
Certified and experienced coders with strong domain expertise in HCC coding and abstraction services.
4. Compliance Audits
Rigorous quality audits to ensure coding practices align with CMS guidelines and regulatory standards.
5. Data Validation and Analysis
In-depth review and analysis of coding data to identify patterns, anomalies, and opportunities for continuous improvement.
Benefits
Partnering with Pro1 Health for your risk adjustment coding needs delivers measurable advantages, including improved coding accuracy, stronger compliance, and optimized reimbursement outcomes.
Data-Driven Insights
We provide meaningful insights through advanced data analysis, supporting informed strategic decision-making for healthcare organizations.
Customized, Flexible Solutions
Our services are tailored to meet each client’s unique operational and business needs, ensuring optimal performance and outcomes.
Continuous Support
We provide ongoing support to ensure seamless integration and sustained success in your risk adjustment coding initiatives.
Enhanced Accuracy and Compliance
We provide ongoing support to help clients stay aligned with the latest coding standards, regulatory requirements, and industry best practices.
Optimized Revenue
Precise coding supports accurate risk assessment and helps ensure appropriate reimbursement for healthcare providers.
Reduced Administrative Burden
Our streamlined coding processes help reduce administrative workload, allowing healthcare providers to focus more on patient care.
Drive accuracy, Improve risk scores
Partner with us for precise, compliant coding that supports better risk adjustment outcomes.