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Expert HCC & HEDIS Abstraction
HCC Coding and HEDIS Abstraction Expertise
At AnnexMed, we offer comprehensive services that focus on optimizing healthcare outcomes and ensuring compliance through Risk Adjustment Coding (HCC) and HEDIS Abstraction. Our experienced coders and clinical staff use industry-best practices to ensure accuracy, maximize reimbursements, and improve overall health plan rankings.
Risk Adjustment Coding (HCC)
Risk adjustment is a crucial statistical process used to predict healthcare costs by accounting for patients’ underlying health status and expenditures. AnnexMed utilizes various risk adjustment models, including CMS-HCC, HHS-HCC, Rx-HCC, and CDPS, to provide precise cost predictions. These models draw from two primary data sources to determine a patient’s Risk Adjustment Factor (RAF):
- Demographic Data: Factors such as age, gender, and population-specific characteristics.
- Health Status Data: ICD-10-CM diagnosis codes, derived from a patient’s medical records.
AnnexMed’s expert HCC coders thoroughly review medical records to validate eligibility and assign appropriate ICD-10-CM codes according to TAMPER (Treatment, Assessment, Monitor/Medicate, Plan, Evaluate, Referral) or MEAT (Monitor, Evaluate, Assess, Treat) criteria. In addition, we identify missed RAF scoring opportunities and address under-documentation issues through a robust Clinical Documentation Improvement (CDI) program. Our prospective and concurrent models ensure that both current and future healthcare expenditures are accurately predicted.
HEDIS Abstraction
The Healthcare Effectiveness Data and Information Set (HEDIS), developed by the National Committee on Quality Assurance (NCQA), is used to evaluate health plans based on the quality of care and services provided. Approximately 90% of managed care plans in the U.S. use HEDIS to measure their performance across six key domains:
- Effectiveness of Care
- Access/Availability of Care
- Experience of Care
- Utilization and Relative Resource Use
- Health Plan Descriptive Information
- Measures Collected Using Electronic Clinical Data Systems
AnnexMed’s highly skilled clinical staff performs HEDIS abstraction by reviewing services relevant to each HEDIS measure, including medical history, lab results, problem lists, and specialist consultations. We follow the latest NCQA guidelines to ensure that all data is collected and reported accurately, helping health plans improve their compliance and streamline the NCQA submission process. By monitoring and enhancing HEDIS performance, we help health plans boost their rankings while meeting submission deadlines.
HEDIS capabilities include:
Medical Record
Retrieval
Data
Abstraction
Prospective
Risk Adjustment
Retrospective
Risk Adjustment
Service Highlights
- Expertise coder in all HCC models
- Detailed chart reviews
- Customized HEDIS reports
- High-Quality data abstraction
Benefits
- Improved RAF score
- Staffing Flexibility
- Care Gap Management
- Improving health plan ranking
Achieve Measurable, Proven Results
Costs Reduced
upto
45%
Reduced operational costs
DNFB Reduced
upto
32%
Reduction in DNFB accounts
Improve Productivity
upto
72%
Productivity improvement
Reduction in AR
upto
36%
Reduction in aged A/R
Improved Collections
upto
98%
Achieve net collections
Reduce Denials
upto
72%
Decrease in denial rate
Years of Experience
Specialties Served
Client Retention
FAQs in HCC Coding & HEDIS Abstraction Services
Why is HEDIS abstraction important for health plans?
Health plans use HEDIS abstraction to ensure compliance with NCQA quality standards, accurately measure care effectiveness, identify care gaps, and improve plan performance and ratings.
What kind of data is reviewed during HEDIS abstraction?
HEDIS abstraction typically involves reviewing clinical documentation such as lab results, physician notes, problem lists, specialist consultations, screenings, preventive care data, and other clinical entries relevant to specific HEDIS measures.
Who performs HEDIS abstraction services?
HEDIS abstraction is typically performed by trained clinical abstractors, often certified coders or nurses with expertise in medical record review and quality measure specifications.
How does HEDIS abstraction improve quality reporting?
By ensuring accurate and compliant extraction of clinical data, HEDIS abstraction improves the reliability of reported quality measures, supports gap closure, and helps health plans achieve better performance scores.
How does HEDIS abstraction help improve health plan ratings?
Effective abstraction ensures complete and accurate measurement of quality metrics, which contributes to higher performance scores, better compliance, and improved overall health plan quality ratings.
Ready to Get Started?
Whether you need full-scale support or help with just one part of the revenue cycle, AnnexMed offers modular services tailored to your most pressing needs.
Let's get started with,
- A quick discovery call to understand your goals
- Insights on how our services align with your workflows
- Guidance on compliance, turnaround, and scaling
- Option to request case study examples
Why AnnexMed?
- 20+ Years of RCM Excellence
- HIPPA Complaince Workflows
- 50+ Specialties Supported
- U.S. Based & Offshore Hybrid Teams
