Solutions

CMS-HCC (Risk Adjustment) Auditing

CMS-HCC (Risk Adjustment) Auditing


The CMS-HCC (Risk Adjustment) auditing module is part of ReviewMate auditing suite and provides:

  • The ability to parse large amounts of HL7 data to “weed out” visits that do not qualify for CMS-HCC reporting
  • After uploading coded data, auditing can be accomplished in any of three ways:
    • Reviewers can audit each patients’ diagnosis codes on an encounter-by-encounter in a granular fashion.
    • Reviewers can access a listing of each patient’s missing HCCs and add them, if appropriate.
    • A listing of the diagnosis and HCCs missing from year to year, by patient, can be provided to interested parties to make decisions, such as, where to concentrate auditing efforts and what patients need to be seen in the current year.
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