IQ Risk Adjustment and HCC Solutions

Delivering audit accuracy, efficiency, and clear guidance

Understanding HCCs

Today, ICD-10-CM coding is ever-evolving and complex. Intellis strives to simplify complicated coding methods by providing a thorough understanding of Risk Adjustment and Hierarchical Condition Categories (HCCs).

Diagnoses have an increasing role in reimbursement. The Risk Adjustment (RA) payment model is based on the assignment of diagnoses to disease groups known as HCCs. HCCs capture the severity of illnesses as well as acute and chronic conditions for patients. Risk scores associated with HCCs are tied to reimbursement and based on documented diagnoses.

Risk Adjustment in Healthcare

Risk Adjustment is associated with Medicare Advantage plans (CMS HCC), Medicare Part D (prescription coverage), the health insurance marketplace under the Affordable Care Act (HHS HCC), and Medicaid managed plans. Current projections predict that up to 40% of Medicare beneficiaries will be in Medicare Advantage plans in the early 2020s and up to 50% by 2025. As the healthcare industry’s reimbursement methodology continues to transition from a “fee-for-service” model to “value-based” care, risk adjustment is more important than ever.

Unparalleled Risk Adjustment and HCC Auditing Expertise

Boasting years of experience and the successful review of thousands of records, our credentialed HCC coders and auditors maintain exceptional accuracy and deliver meticulous work. With IntelliScope, our proprietary data analytics tool, we identify potential losses and gains and highlight missed opportunities. We then conduct IQ education sessions that determine pitfalls, patterns, and trends that can lead to optimized RAF (Risk Adjustment Factor) scores.

No one is better prepared to handle RA/HCC assessments and education than our Intellis IQ subject matter experts. Unmatched expertise:

  • Credentialed IQ leadership team: RN, RHIA, RHIT, CCS, CCDS, CDIP, CRC, CPC
  • Advanced knowledge of the CMS landscape
  • Provided significant consulting input on various federal agency coding procedures
  • Partnered with providers in leading medical centers to assess, educate, and implement inpatient & outpatient CDI practices
  • Reviewed over 40,000 records while managing audit processes
  • Performed the Secondary Validation Audit (SVA) for a Risk Adjustment Data Validation (RADV) audit for the past four years
  • Presented Intellis IQ education sessions that identify pitfalls, patterns, and trends that can lead to optimized RAF (Risk Adjustment Factor) scores

Precision-Driven Data Analytics

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Our clients benefit from IntelliScope, Intellis’ proprietary data analytics toolset. IntelliScope supports each of our services by analyzing key metrics to pinpoint value, identify prospective losses and gains, and highlight opportunities for growth — providing vital industry wisdom and insights. As a prospective value calculation tool, IntelliScope supports our HIM services by ensuring the accuracy of our data analytics in projecting reimbursement losses and gains.

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Learn More About the Services and Solutions
that Intellis Offers

7025 County Rd 46A
Suite 1071-512
Lake Mary, FL 32746
General Information

(866) 840-6052