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 documentation are vital.
Our expert team helps you navigate these complexities, ensuring compliance, enhancing risk adjustment accuracy, and improving overall performance. To support this process, we incorporate MedGenX, our proprietary automated medical coding software that improves accuracy, reduces abstraction errors, and strengthens documentation review. 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 abstraction is the process of capturing patient data based on HEDIS measures, ensuring healthcare organizations accurately report quality metrics and maintain compliance.
Our clinical documentation specialists 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
- AI-assisted data precision
- 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 classification systems, our experts accurately capture diagnoses and services in claims data according to NCQA and regulatory specifications.
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Comprehensive review
We review patient charts, claims, and other records to identify and code all services and outcomes for thorough quality reporting, ensuring critical information is never overlooked.
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risk adjustment
We ensure precise HCC documentation 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 data 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 current with NCQA quality measures, CMS risk adjustment updates, and changes affecting coding requirements, aligning with industry standards and best practices.
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Timely reporting
We prioritize timely data submissions to meet reporting deadlines, ensuring full compliance and helping to avoid penalties or negative impacts 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 compliance-focused medical review ensures that healthcare services, procedures, and diagnoses align with established quality measures. The process includes:
Data extraction
Collecting essential data points from medical records, including patient demographics, diagnoses, procedures, and medications. MedGenX automates data extraction, ensuring no critical details are missed.
Compliance comparison
Analyzing the extracted data against quality reporting measures and guidelines to determine adherence to quality standards.
Gap identification
Identifying 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 AI-enhanced coding solutions support your Quality Improvement Program (QIP), helping to continuously improve healthcare quality using quality performance data.
We serve all 50 states
HEDIS Coding Process
Our systematic HCC coding process accurately captures and document patients’ health conditions with precision, combining human expertise and AI-driven insights.
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
ICD-10 codes and HCC codes are correctly assigned by our AI medical coding platform, reflecting the complexity of each patient’s health status and 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 documentation and code assignment supported by AI-driven validation
- Fast turnaround: Quick processing times, timely submissions and reimbursements, powered by MedGenX
- Specialty-specific expertise: Tailored coding solutions across various specialties
- Stay updated on regulations: Meet compliance requirements
- Implement best practices: Optimize your code assignment processes
- Seamless integration, smooth workflow: We operate as an extension of your practice
FAQs
What is HEDIS coding?
HEDIS data abstraction involves collecting and documenting patient data according to HEDIS measures, ensuring healthcare organizations accurately report quality metrics and meet compliance requirements.
Why is HEDIS coding important?
Accurate HEDIS data abstraction is crucial for evaluating the quality of care provided by healthcare organizations. It impacts reimbursement rates, regulatory compliance, and overall performance in managing patient care.
What are the qualifications of your HEDIS coding team?
Our HEDIS team consists of certified specialists and experienced abstractors with extensive knowledge of HEDIS measures and documentation guidelines. They stay up-to-date with industry changes to ensure compliance and accuracy.
How does HEDIS coding affect reimbursement?
Accurate HEDIS data abstraction helps healthcare organizations demonstrate quality of care, enhancing 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 abstraction involves collecting 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 medical record review process includes extracting relevant data from patient records, comparing it against established HEDIS criteria, and identifying areas for improvement. This ensures organizations meet the required quality standards and remain compliant.
How can your services help improve HEDIS scores?
Our services include expert data abstraction, rigorous audits, and comprehensive reporting. By ensuring accurate documentation and identifying care gaps, we help healthcare organizations improve their performance metrics and strengthen overall quality outcomes.
Can HEDIS coding be automated?
Yes. With MedGenX, much of the HEDIS data abstraction is automated, identifying key diagnoses and care gaps quickly. Coding specialists then review the results to ensure accuracy and speed up the process.
How do I get started with your HEDIS coding services?
Contact us for a consultation. We’ll review your needs and develop a customized solution to enhance your reporting workflow and improve documentation accuracy.
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