The facts

Finding and sustaining resources with the expertise to accurately code risk-adjustable conditions—while also ensuring regulatory compliance—can be difficult. Although new technologies, such as artificial intelligence (AI) and natural language processing (NLP) can augment coding efficiency, these tools can’t entirely replace the expertise of a certified coding professional. Health plans need a partner with the scale, resources, and flexibility to manage compliant coding efficiently and effectively.  

Cotiviti’s AAPC- or AHIMA-certified clinician coders have an in-depth understanding of risk adjustment coding standards and specific Centers for Medicare & Medicaid Services (CMS) rules and guidelines. Our coders review digitized medical records, considering the appropriate diagnosis condition hierarchies and interactions. They provide thorough code capture from a member’s medical chart to ensure that all appropriate diagnoses are identified and supported in preparation for submission to CMS. On average, 96 percent of Medicare charts suspected, retrieved, and coded by the Cotiviti Risk Adjustment team contained undocumented chronic conditions.