HEDIS Abstraction

Patient Access Services

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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.