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Hierarchical condition category (HCC) coding Services

The purpose of the risk-adjustment model known as Hierarchical Condition Category (HCC) coding was to better predict the financial burden of treating individual patients. The CMS HCC model, which was first implemented in 2004, is gaining popularity as the healthcare industry moves towards value-based payment structures.

ICD-10 coding is used by the Hierarchical Condition Category (HCC) to evaluate patient risk. The ICD-10-CM codes for each HCC are listed below. When determining a patient's RAF score, insurance companies use HCC coding in addition to demographic information (such as age and gender). Insurance companies can utilize a patient's RAF score to estimate future expenses with the use of algorithms. It is reasonable to assume that a patient who has few major health concerns will incur typical medical costs during a particular time period. Although health care costs and use are both likely to be higher for a patient with many chronic illnesses.

RM Healthcare HCC Coding Expertise

When it comes to HCC Coding Services, RM Healthcare is a frontrunner thanks to its extensive worldwide delivery approach and team of expert coders. Retrospective chart audit Services from RM Healthcare's Risk Adjustment solutions can help Health Plans dramatically boost performance by locating incorrectly coded, uncoded, or under-coded charts as well as the accompanying gaps in clinical documentation. We assist health plans in defining risk adjustment strategies and locating members who provide a high return on investment.

We have a team of qualified medical coders on hand, all of whom hold credentials from the American Association of Professionals in Coding (AAPC) and the American Health Information Management Association (AHIMA). Audits of medical records are one of our specialties, and we also offer retrospective chart reviews, audits of RADV and validation, and RADV audit services.


  • Coding experts who have passed the AAPC's rigorous certification process conduct audits of compliance and complete comprehensive chart reviews.
  • Analyzing data from medical records from all settings.
  • Observance of CMS's risk adjustment reporting requirements and official coding standards.
  • Look into medical records for missed diagnosis or mistakes.
  • Achieving a correct HCC value for each MRA Diagnosis code.
  • At RM Healthcare, we maintain industry-leading coding standards with the help of a rigorous auditing process.
  • On top of that, we run intensive training programs to ensure our coding skills sharp.
  • Coding Methods for Part C (HCC): Annual Capture or Encounter-Based on RADV.
  • Reporting Suspects: Diagnosis Deduced From Clinical Indications.
  • Audited over 1.9 million charts from 2018 through 2022.
  • Large number of qualified backup team members, with whom you can start working right away.


Our HCC Coding Services Delivery Model

  • Dedicated Account Managers
  • One of the largest Pool of Certified HCC Coders
  • Comprehensive Reporting
  • Unmatched HCC Expertise


RM Healthcare handles more than 250,000 patient support calls each month