95+
Coding Accuracy
95-98%
Claim Accuracy
40%
Overhead Cost Savings
HEDIS Abstraction Done Right: Maximize Compliance and Reimbursement
Is your healthcare organization struggling to meet HEDIS performance benchmarks?
With quality measures crucial for both reimbursement and patient care, accurate Healthcare Effectiveness Data and Information Set (HEDIS) abstraction and HCC coding are vital.
Our expert team helps you navigate these complexities, ensuring compliance, enhancing risk adjustment accuracy, and improving overall performance. Our services capture the quality of care you provide while optimizing outcomes and maximizing reimbursement. We also help health plans monitor performance and boost HEDIS scores for better results.
Optimize Revenue through Targeted HEDIS Coding
HEDIS coding is the process of abstracting and coding patient data based on HEDIS measures, ensuring healthcare organizations accurately report quality metrics and maintain compliance.
Our coding experts have extensive experience in capturing chronic conditions, comorbidities, and other risk factors that impact patient care. Our team ensures that all relevant diagnoses are accurately documented and coded to meet CMS and HEDIS requirements. Our support covers medical record review, extraction of relevant data points, assigning appropriate codes for accurate and consistent reporting, and compliance audits.
Benefits of Partnering with Us
- Experienced HCC coders
- Accurate risk adjustment
- Seamless integration
- Cost-efficiency
- Scalability
- Custom reporting
- Enhanced care quality
- Compliance assurance
- Scalability
- Continuous support
Top-Notch HEDIS Coding Expertise
Our team’s expertise can ensure accuracy and efficiency in coding for HEDIS compliance.
Proficiency in coding
Experienced in ICD-10, CPT, CPT II, HCPCS, and other coding systems, our expert team can ensure accurate capture of diagnoses and services in claims data according to HEDIS specifications.
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Comprehensive review
We review patient charts, claims, and other records to identify and code all services and outcomes for comprehensive HEDIS reporting, ensuring critical information is not overlooked.
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risk adjustment
We ensure precise HCC coding for conditions like diabetes, kidney disease, and heart failure, which significantly affect risk scores and reimbursement levels for high risk patients.
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Rigorous auditing
Our regular audits and validations ensure coding accuracy, meticulously addressing flaws that could result in compliance risks or lost revenue, maintaining the integrity of the coding process.
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Up-to-date knowledge
We stay updated on NCQA’s HEDIS measures and CMS risk adjustment updates, and changes that influence HEDIS coding requirements, aligning with industry standards and best practices.
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Timely reporting
We focus on timely data submissions to meet HEDIS deadlines, fully compliant with reporting standards, helping to avoid potential penalties or adverse effects on reimbursement rates.
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HEDIS Medical Record Review
We provide a thorough evaluation and analysis of medical records to assess the quality of care delivered by healthcare organizations and health plans. Our HEDIS medical record review services ensure that specific healthcare services, procedures, and diagnoses align with HEDIS criteria. The process includes:
Data extraction
Collecting essential data points from medical records, including patient demographics, diagnoses, procedures, and medications.
Compliance comparison
Analyzing the extracted data against HEDIS measures and guidelines to determine adherence to quality standards.
Gap identification
Highlighting areas of non-compliance, gaps in care, and opportunities for quality improvement.
We provide HEDIS medical record review services on a regular basis, tailored to your preferred frequency and needs. Our HEDIS coding solutions can support your Quality Improvement Program (QIP) continuously improving the overall quality of healthcare services using HEDIS data.
We serve all 50 states
HEDIS Coding Process
Our systematic HCC coding process to accurately capture and document patients’ health conditions involves the following steps:
1
Patient Record Review
2
Accurate Coding
3
Data Validation
4
Reporting & Submission
Patient Record Review
Our certified coders carefully examine patient charts and clinical documentation to identify all relevant diagnoses and comorbidities.
Accurate Coding
Utilizing ICD-10 codes, they assign appropriate HCC codes to reflect the complexity of each patient’s health status, capturing all chronic conditions.
Data Validation
We conduct thorough audits to validate coding accuracy and compliance with CMS guidelines, addressing any discrepancies.
Reporting and Submission
The accurately coded data is submitted to relevant payers in a timely manner, maximizing reimbursement opportunities.
Affordable and Flexible Pricing Options
Based on your needs and budget, you can choose from the following payment options:
Full-Time Equivalent
In this model, services are billed based on the equivalent cost of a full-time employee (FTE) for a specified duration, usually monthly or annually.
Per Verification Billing
Like an FTE model, a person is dedicated to your practice. Perfect for a practice that is busy. They work as an extension to your business.
FTE/Per Verification Billing
This option is ideal for a practice that is unsure about their work requirements. This can have per request pricing for eligibility and other functions.
Why Choose Us as Your Medical Coding Outsourcing Partner
- Project manager: Dedicated project manager to oversee your account
- Leverage expertise: maximize reimbursement and minimized denials
- Cost savings: Achieve 30-40% savings on overhead costs
- Experience flexibility: no long-term contracts or upfront fees
- Rigorous quality assurance: ensure accurate coding and compliance
- Fast turnaround: Quick processing times, timely submissions and reimbursements
- Specialty-specific expertise: tailored coding solutions across various specialties
- Stay updated on regulations: meet compliance requirements
- Implement best practices: optimize your coding processes
- Seamless integration, smooth workflow: We operate as an extension of your practice
FAQs
What is HEDIS coding?
HEDIS coding involves the process of abstracting and coding patient data according to the Healthcare Effectiveness Data and Information Set (HEDIS) measures. It ensures that healthcare organizations accurately report quality metrics and meet compliance requirements.
Why is HEDIS coding important?
HEDIS coding is crucial for evaluating the quality of care provided by healthcare organizations. It impacts reimbursement rates, compliance with regulatory standards, and the overall performance of health plans in managing patient care.
What are the qualifications of your HEDIS coding team?
Our HEDIS coding team consists of certified coders and experienced abstractors with extensive knowledge of HEDIS measures and coding guidelines. They stay up-to-date with industry changes to ensure compliance and accuracy.
How does HEDIS coding affect reimbursement?
Accurate HEDIS coding helps healthcare organizations demonstrate the quality of care delivered, which can enhance reimbursement rates from payers. Proper documentation and coding ensure that organizations receive appropriate compensation for the services provided.
What types of data are collected during HEDIS coding?
HEDIS coding involves collecting various data points, including patient demographics, diagnoses, procedures, medications, and preventive care services. This data is essential for assessing compliance with specific HEDIS measures.
How often are HEDIS measures updated?
HEDIS measures are typically updated annually by the National Committee for Quality Assurance (NCQA). It is important for healthcare organizations to stay informed about these changes to ensure accurate coding and compliance.
What is the process for HEDIS medical record review?
The HEDIS medical record review process involves extracting relevant data from patient records, comparing it against HEDIS criteria, and identifying areas for improvement. This process ensures that healthcare organizations meet quality standards and compliance requirements.
How can your services help improve HEDIS scores?
Our HEDIS coding services provide expert data abstraction, rigorous audits, and comprehensive reporting. By ensuring accurate coding and identifying gaps in care, we help healthcare organizations improve their HEDIS scores and overall quality performance.
How do I get started with your HEDIS coding services?
Contact us for a consultation. We’ll discuss your specific needs and develop a customized solutions to enhance your HEDIS coding and reporting processes.
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