MedConverge, LLC., is a full service revenue cycle management and medical coding company. We specialize in outpatient and inpatient hospital coding, risk adjustment coding (CMS-HCC coding), chart audits for documentation gaps, and ICD-10 training/implementation. Our coders are certified from AAPC and/or AHIMA. Our senior team has nearly a decade of experience in HCC coding. We currently also work with ACOs.
At MedConverge, We have an in-depth understanding of all the key aspects guiding HCC coding. Our coders review all sources of documentation over the rolling 12-month period to understand the severity of a disease and assign the most appropriate diagnostic codes. This ensures that the highest and most accurate hierarchical condition categories are assigned to patients. We review all key sources of documentation including principal hospital inpatient, secondary hospital inpatient, hospital outpatient, physician, and clinically trained non-physician medical records. We do retroactive risk adjustment reviews because we understand that some diseases manifest over time. It is important to note that Medicare Advantage Organizations allow for retroactive risk adjustments.
With our years of experience, we understand that volumes peak as MAOs approach RAPS (Risk Adjustment Processing System) deadlines, which is why our workflow process keeps track of volumes to avoid over peaking of volumes around deadlines. Our dedicated account managers work in tandem with our clients to build and maintain strong relationships with healthcare providers. We educate and provide constant feedback to providers on potential documentation gaps and the diagnostic codes that are critical to risk adjustment. We also work with providers to develop standardized information request processes. We uphold all coding standards and we annotate and keep a track of all documents we have utilized to arrive at a particular HCC category.