Capturing the complete clinical complexity of your patient population is critical to achieving fair reimbursement and quality incentives under Medicare Advantage, ACA, and ACO payment models.
In risk-adjusted payment environments, missing a chronic condition code (such as diabetes with microvascular complications, CHF, or CKD staging) directly suppresses your Risk Adjustment Factor (RAF) score. This leads to substantial under-funding while leaving your practice exposed to CMS RADV audit scrutiny.
V1RCM's Certified Risk Adjustment Coders (CRC) utilize deep knowledge of CMS-HCC and HHS risk models to identify unrecorded or under-documented conditions from provider encounter notes, laboratory results, and historical diagnostic records.
Our risk adjustment specialists hold active Certified Risk Adjustment Coder (CRC) and Certified Professional Coder (CPC) credentials from AAPC, with extensive training in CMS guidelines and ICD-10-CM official coding conventions.
Yes. We integrate securely into Epic, Cerner, AthenaHealth, NextGen, eClinicalWorks, and others via role-based secure credentials, conducting chart reviews without disrupting your clinical team's day-to-day workflow.