HCC Risk Adjustment Validation

Improve accuracy. Strengthen compliance. Optimize reimbursement.

The Challenge

Risk Scores Drive Reimbursement – But They Must Be Backed by Documentation

Hierarchical Condition Categories (HCCs) determine Medicare Advantage and other risk-adjusted payments. If diagnosis codes are reported without proper documentation, organizations face overpayments, audit risk, and potential reimbursement takebacks. On the flip side, missed codes or incomplete documentation means leaving revenue on the table.

Common issues include:

Missing or incomplete documentation to support reported HCCs
Incorrect or outdated ICD-10-CM code usage
Inaccurate risk scores that impact revenue and benchmarking
Increased scrutiny from CMS and the OIG

OUR SOLUTION

Validate Risk Scores and Protect Payment Integrity

HIP’s HCC Risk Adjustment Auditors evaluate your documentation and coding practices to ensure every risk-adjusted code is accurate, supported, and compliant. We help uncover gaps, reduce audit exposure, and maximize appropriate reimbursement.

What we deliver:

Chart audits for ICD-10-CM codes mapped to HCCs
Validation of diagnosis documentation across settings
Identification of missed risk-adjusted conditions
Audit readiness and regulatory compliance reviews
Provider and coder education sessions

HOW IT WORKS

How We Improve Risk Adjustment Accuracy

Audit. Educate. Optimize.

Evaluate Current Risk Adjustment Performance
We review your HCC coding and documentation practices across both inpatient and outpatient settings.
Perform Targeted Chart Audits
Each reported condition is validated for clinical accuracy, relevance, and compliance with CMS guidelines.
Report Gaps and Opportunities
You receive clear insights into missed HCCs, documentation gaps, and areas of over- or under-coding.
Train Staff for Ongoing Accuracy
We provide customized education to physicians, coding teams, and CDI staff to support long-term improvements.

Why Choose HIP for HCC Risk Adjustment

Specialized auditing to improve HCC documentation integrity, strengthen compliance, and support accurate, risk-adjusted payment.

100% U.S. Based

No offshoring. All staff reside and work in the U.S.

AHIMA/AAPC

Every coder holds active credentials.

Proven Professionals

10 years of experience on average

Rapid Deployment

Get support mobilized in days, not weeks.

No Contracts

Flexible engagements with no minimum volume.

Monthly QA Reviews

Ongoing audits for accuracy and compliance.

Strict Vetting

Drug tests, credential verification, etc.

Direct Oversight

Projects led by experienced managers, not freelancers.

Stay Informed

Our quarterly newsletters share timely insights across all service lines - including regulatory updates, reimbursement trends, documentation best practices, and compliance strategies.

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Validate Your Risk Scores With Confidence

Stay compliant, recover revenue, and make sure your documentation tells the full patient story.

Validate Risk Scores