CMS-HCC (Risk Adjustment) Module


The CMS-HCC (Risk Adjustment) Module of ReviewMate offers three different ways to audit for Risk Adjustment:

  1. Reviewers can audit each patients’ diagnosis codes on an encounter-by-encounter basis, or,
  2. Reviewers can access a listing of each patient’s missing HCCs and add them, if appropriate, or,
  3. 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.

The CMS-HCC module provides:

  • Accuracy rates for HCC and overall diagnosis coding.
  • Identification on the auditor’s screen of diagnosis codes that hold HCC value. This eliminates the need for auditors to look up HCC values on a spreadsheet.
  • Overridden HCCs due to the hierarchy structure are identified on the screen so the auditor can readily see which diagnosis codes will be considered into the patient’s score.
  • Original, revised and net HCC weight for each calendar year.
  • Each calendar year for each patient has an “Analyzer” button where the auditor can view what diagnoses and HCCs are missing for a particular calendar year.
  • Full suite of references including Coding Clinic, AHA Coding Handbook, Clinotes and code look-up eliminating the need for an outside product to perform research.
  • Communication between auditors and coders within the software to discuss findings and recommendations.
  • Reconciliation of rebuttals occurs inside of ReviewMate. Conversations between the auditor and coder are saved and can be accessed by any user.
  • Accuracy rates are available real-time.
  • Extensive library of customizable reports from raw data to Executive Summaries.
  • Customizable dashboards to enhance the user experience.
  • Multiple user levels allow view-only access to any interested parties providing transparency to all interested parties.