What’s in scope.
The list below describes the standard work breakdown. Every engagement is scoped to client volume, line of business, and platform. Bespoke scope is the default, not the exception.
- 01
Prospective Risk Adjustment
In-home assessments, telehealth assessments, and provider-facing suspect lists tied to documentation gaps.
- 02
Retrospective Chart Review
Two-pass coding: first-level by CRC-certified coders, second-level by senior auditors. Full traceability.
- 03
Sweep Season Operations
Encounter Data System submissions, MAO-004 reconciliation, RAPS-to-EDS validation, and error correction at scale.
- 04
RADV Audit Response
Sample chart pulls, defensibility briefs, error reconciliation memos, and statistical extrapolation challenges.
- 05
HHS-HCC Programs
ACA marketplace risk-adjustment programs — full validation, true-up modeling, and EDGE server compatibility.
- 06
Overpayment Defense
Where CMS asserts overpayments, we build the defensibility record. Our average overturn rate on contested codes exceeds 60%.