How to Improve Medicare Risk Adjustment Scores

Posted by Lucy Medina on Sep 1, 2020 12:01:59 AM
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As enrollment in Medicare Advantage plans grows, healthcare organizations need to be able to predict future healthcare financial resources and appropriate reimbursement. The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to estimate predicted costs for Medicare Advantage beneficiaries, and the results directly impact the reimbursement healthcare organizations receive. 

CMS uses the CMS–hierarchical condition category (CMS– HCC) model to risk adjust MA payments. This model uses beneficiaries’ demographic information and diagnosed medical conditions gathered into hierarchical condition categories (HCCs) to predict their costliness. Many organizations today struggle to achieve optimal documentation that will help them increase RAF scores and funding from medicare advantage contracts. Having a successful strategy implemented to improve medicare risk adjustment scores for your practice can help reduce underpayments, enhance quality of care and improve funding. 

The infographic guide below presents relevant data and HCC coding best practices to help you improve medicare risk adjustment scores.


It is important to highlight the importance of using HCC coding technology to make documentation easier and help improve patient's RAF scores.

Inferscience’s HCC coding application helps providers optimize HCC coding and risk adjustment documentation. HCC Assistant is a cloud-based intelligent HCC coding and billing platform which is integrated with major EHRs. The platform utilizes advanced Natural Language Processing (NLP) to analyze unstructured data as well as utilizing standardized vocabularies to analyze structured data in the patient chart. The complex intelligent rules built into the HCC Assistant allow it to find diagnoses that may have been overlooked and represent opportunities to improve the documentation in real time. Where available, write back integration enables one click submission of HCC ICD-10 codes and supporting plan of care documentation back into the patient chart.

If you’re a healthcare provider looking for HCC Coding technology tools you can visit our website at or contact us at 617 848 9502. 

Topics: Medicare, hcc coding tools, hcc coding technology

About the Author

Lucy Medina is an experienced healthcare marketer with expertise in payer contracting and revenue cycle management. She joined Inferscience in the spring of 2019. Inferscience offers an HCC Coding tool that integrates with leading EHRs and HIT systems to analyze patient records and claims information to help physicians and coders capture and audit HCC codes within their workflows. With Inferscience’s HCC Assistant, Physicians can document HCC codes and plan of care information in real-time during the patient encounter. Now, one solution enables both payers and providers to succeed in today's value-based care market.

Learn more about Inferscience and HCC Coding Assistant by visiting our products page here.