BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM Medical coding
🟢 Risk Adjustment Coding Services
Drive Revenue with Accurate Risk Adjustment Coding
Dedicated to Delivering High-Quality Risk Adjustment Coding
Schedule a Call≤2%
Audit-grade HCCs
90 %+
Prior-Year Recapture Rate
≤1%+
RADV Disallowance Rate
Overview
Hierarchical Condition Categories (HCC) Coding Expertise
From prospective and concurrent reviews to targeted chart evaluations and advanced validation processes, each method plays a crucial role in improving coding accuracy and aligning with regulatory requirements
Coding using Hierarchical Condition Categories (HCC)
Our certified coding specialists focus on HCC coding, precisely recording patient conditions to represent their actual health status and risk ratings.
Chart Reviews and Data Validation
We thoroughly evaluate patient charts and data to identify missing or inaccurate diagnoses.
Advanced Workflow Technologies
We employ cutting-edge workflow management technologies to expedite turnaround times, increase efficiency, and simplify coding
Auditing and Compliance Services
We employ cutting-edge workflow management technologies to expedite turnaround times, increase efficiency, and simplify coding
Tailored data and Analytics
We provide in-depth data and analytics to help you comprehensively understand your risk adjustment performance
Operations
Comprehensive Risk Adjustment and Coding Quality Services
This heading reflects the full scope of services, emphasizing the focus on accuracy, compliance, and optimization of risk adjustment and coding processes. It is professional, clear, and aligns with the audience's expectations in the healthcare domain
Prospective Reviews
Prospective reviews, conducted before patient encounters, help identify patients with potential risk adjustment opportunities
Concurrent Reviews
Concurrent reviews help ensure that all relevant diagnoses are documented and coded accurately at the point of care, reducing the need for retrospective corrections
Retrospective Reviews
Retrospective reviews are carried out after patient encounters. They involve analyzing past medical records to identify missing or incorrect codes
Targeted Chart Reviews
Targeted chart reviews focus on high-risk patients or those with complex medical histories and aim to identify specific coding opportunities
Comprehensive Chart Reviews
Thorough reviews of a patient’s medical record are needed to ensure that all relevant diagnoses are accurately documented and coded
Focused Encounter Reviews
Reviews centered around specific patient encounters (e.g., annual wellness visits, hospital admissions) where coding opportunities may be more prevalent
Risk Adjustment Data Validation (RADV) Reviews
RADV reviews help identify discrepancies and mitigate compliance risks
HCC Suspecting Reviews
Utilizing advanced analytics and machine learning algorithms, HCC suspecting reviews help identify potential diagnoses that may not have been documented based on patient clinical data patterns
Quality Assurance Reviews
A final layer of review to ensure that all coding practices adhere to internal quality standards and regulatory requirements
Dual Coding Reviews
Conducted to compare coding results from two separate coders or teams to ensure consistency and accuracy
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have securely received your patient and encounter data, we code, review, and submit claims to payers. We manage appeals and denials, track payments, and provide regular updates. Our process is designed to be efficient and transparent.
Our certified coders and billing specialists review every claim carefully. We use quality‑control checks, regular coding audits, and payer‑specific validation to reduce coding errors and the risk of denials.
Our denial‑management team reviews each denied claim to identify root causes. We correct issues, resubmit claims promptly, and, when needed, pursue appeals with payers to maximize reimbursement.
We offer flexible pricing tailored to client needs — including fixed fees, per‑claim pricing, or percentage‑of‑collections models depending on volume and services required. Contact us for a custom quote.
Yes. We specialize in seamless transitions from in‑house systems or other vendors. To ensure secure data migration, our team works closely with you and provides training as needed.
Resources
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