HCC Gap Identification
Find chronic conditions that were treated but not documented or coded correctly during the year.
Retrospective Review evaluates patient documentation after the date of service, giving organisations a complete and detailed look at chronic conditions, coding accuracy, and missing supporting elements.
Find chronic conditions that were treated but not documented or coded correctly during the year.
Ensure each diagnosis meets documentation guidelines including MEAT or TAMPER validation.
Identify coding inconsistencies, unsupported diagnoses, and opportunities for corrected submissions.
Send targeted queries to clinicians to reconcile unclear or incomplete documentation.
Package findings into compliant summaries for risk adjustment submission and audit defence.
Assist with final-year risk capture cycles, ensuring no chronic conditions are overlooked before deadline.
Gather all available patient records, including specialist notes, labs, imaging, and prior coding.
Identify symptoms, encounters, or treatments suggesting undocumented chronic conditions.
Cross-check diagnoses with HCC models and validate with MEAT/TAMPER rules.
Request missing details or clarification from providers when documentation is incomplete.
Create audit-ready summaries for validated diagnoses.
Prepare findings for final risk adjustment submission or reconciliation cycles.