Risk Adjustment Documentation and Coding

Do you contract with a Medicare Advantage Organization or other payer using a risk adjustment methodology? Are your coders accurately capturing chronic health conditions? Have you been through a RADV audit?

If you are struggling with your risk adjustment methodology, it may be time to ask for help.

Accurate risk adjustment data directly affects payment to Medicare Advantage Organizations and others. Because of this, complete medical record documentation and accurate diagnosis coding is a critical goal. The Centers for Medicare and Medicaid Services (CMS) uses CMS hierarchical condition categories (HCC) to compensate Medicare Advantage Plans for their aged and disabled beneficiaries. CMS-HCCs are assigned to individual patients based on documented diagnoses and are an integral part of a much larger reimbursement calculation.

The complexities of risk adjustment coding and documentation can be daunting for health plans and providers. Let the Baker Newman Noyes (BNN) revenue cycle team help relieve your concerns and ensure you are in compliance.

How We Help

  • Coding assessments
  • Clinical documentation improvement
    • Accurate CMS-HCC assignment
  • Compliance guidance
  • Medical record documentation
    • Data/demographic capture
    • HCC categories
  • RADV services
    • Mock audits
    • Review of claims for submission
    • Assistance with actual RADV audits
  • Financial considerations
  • Coder quality assurance programs
  • Provider education
  • Coder education

A Partner for You

Our approach to risk adjustment is focused on best practices. We partner with our clients to ensure our assistance is meaningful, timely and objective. Our certified risk adjustment coders (CRC) are trained for enhanced precision and accuracy in identifying the composite picture of a patient’s health status.

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Lead Contacts

Paul Letalien

Principal

Paul began at Baker Newman Noyes in 1995 as one of the founding members. Prior to entering public accounting, he served as CFO at a multi-level healthcare provider.

Janet Hodgdon

Director of Healthcare Development

Jan is a director in the healthcare consulting practice at Baker Newman Noyes, specializing in revenue cycle management, finance, provider education and training, risk adjustment documentation and coding, 501(r) Treasury regulations, and third-party reimbursement.

Team Members

C. Dayton Benway Pamela Cook Maggie Fortin Gina Hobert Denis Houle Marc Levy Roland Mercier Stephanie Richio Dianne Rodrigue Brett Seekins Shane Williams