HCC coding
Reviewing medical records and abstracting supported diagnoses that map to HCCs, following official coding guidelines and your plan's policies.
04 / Risk adjustment
Risk adjustment and HCC coding support for health plans
High chart volumes, documentation questions and coding inconsistencies make risk adjustment work difficult to manage at scale. Accancy supports health plans with HCC coding, chart review and validation workflows that focus on the documentation behind each code, so results are consistent and defensible.
Discuss risk adjustment supportSigns your team could use support
- Chart review volumes exceed in-house capacity
- Coding results vary between reviewers or vendors
- You need a second-level validation of codes before submission
- Audit readiness depends on documentation that is hard to trace
- Deadlines for data submission are putting pressure on the team
What our risk adjustment support includes
Chart review
Retrospective review of member charts at volume, organised by your priorities and submission timelines.
Coding validation
Second-level review of codes already captured, confirming each is supported by documentation and flagging those that are not.
Documentation review
Checking that each code is backed by documentation that would stand up to review, with findings recorded so they are easy to trace later.
Who it's for
Medicare Advantage, ACA and Medicaid managed care plans, and organisations that support them, that need dependable chart review and coding validation capacity.
How an engagement starts
- Understand. Talk through your current workflow, workload and the issues your team needs help with.
- Define. Confirm the scope, systems access, review process and reporting expectations.
- Begin. Align on onboarding and handoffs, then review progress together as the work gets underway.
Frequently asked questions
What is HCC coding?
Hierarchical Condition Category (HCC) coding groups diagnoses documented in a member's medical record into categories used in risk adjustment models. Accurate, well-documented HCC coding helps a plan's risk scores reflect the real health status of its members.
Do you only add codes, or remove unsupported ones too?
Both. Our validation work confirms codes that are supported by documentation and flags codes that are not, which matters as much for audit readiness as finding missed conditions.
How do you keep coding consistent across reviewers?
We agree coding guidelines, review criteria and quality sampling with you up front, and report quality findings alongside volume.
How is member data protected?
Access, confidentiality and data-handling requirements are set during onboarding, and protected health information is handled under a Business Associate Agreement.