Risk adjustment services, led by physicians and certified coders
Accurately align coding and documentation to reflect your patient complexity in your Medicare and Medicare Advantage risk arrangements.
Getting risk capture right is pivotal to benchmarking total cost of care
Clinical teams have a few minutes per patient and years of records spread across systems. With V28 fully phased in and RADV audits expanding, value-based organizations need a partner who can surface what is missing, remove what is unsupported, and fit into the way their physicians already work.
HCC coding support before, during, and after every encounter
IKS Health supports Medicare ACOs and care delivery organizations taking Medicare Advantage risk, providing expertise in CMS-HCC and Rx-HCC coding.
Pre-visit
Prospective risk adjustment
IKS physicians review the previous 24 months of a patient’s records before the appointment, suspect new diagnoses, and validate conditions that need recapture this year. The provider sees the findings at the point of care and decides what to address.
Post-visit, pre-bill
Concurrent HCC coding
Certified coders review each visit using MEAT criteria to add, revise, or delete diagnoses and querying providers when documentation is unclear. Corrections happen before the claim is released.
Post-claim
Retrospective chart review
Certified coders review claims using MEAT criteria to support addenda and supplemental data submissions, capturing documented conditions that were missed on the original claim.
Documentation, physician education, and audits that strengthen every HCC
Beyond coding, IKS Health improves documentation at the source, helps providers get better with every cycle, and keeps every code ready for audit.
Clinical documentation improvement (CDI) services
CDI specialists and IKS physicians review notes for V28 specificity and MEAT support, and send compliant, non-leading queries inside the provider's workflow.
Provider education
One-on-one sessions, specialty tip sheets, and V28 updates, built from each provider's own findings and audit results, close recurring documentation gaps.
Risk adjustment audits
Certified coders audit charts coded by your team, another vendor, or IKS Health. Mock RADV reviews flag unsupported codes and show your exposure ahead of a CMS audit.
Results from risk adjustment support with our partners today
The Jackson Clinic earns a 21x return from prospective HCC coding
IKS Health identified potential new diagnoses before visits and delivered recommendations within existing workflows; clinicians accepted 72% of recommendations over the reported period.
21x
return on
investment
$3.54M
shared savings
opportunity
+0.38
RAF in patients with new
HCCs
Physician-led suspecting across 70,000 patients in full v28
Four care delivery organizations across the US brought in IKS Health for prospective chart review. Our physicians reviewed 24 months of records per patient to suspect new diagnoses and validate recaptures.
36 points
RAF improvement
per patient under V28
18%
of patients had
net-new HCCs
78%
provider
acceptance rate
Risk adjustment resources
Client Stories Improved risk capture and identified embedded chronic conditions with IKS Health clinical chart review
Blogs The Evolution of CMS-HCC Models: V28’s Impact on Patient Care and Risk Adjustment
Accurately capture risk with IKS Health
Share a sample of upcoming visits or recent encounters. Our risk adjustment team will show you where conditions are going unaddressed, where documentation would not hold up in an audit, and what a program built around your clinicians could return.
Frequently asked questions
How does IKS Health improve risk capture?
IKS Health combines physician-led prospective chart reviews with certified-coder validation to identify conditions that may be missing from a patient’s current risk profile. By reviewing up to 24 months of patient history, our physicians identify clinically supported conditions and recapture opportunities before the visit, giving providers the context they need to make informed clinical decisions. This approach helps organizations develop a more complete picture of patient risk while supporting appropriate reimbursement and quality care delivery.
What is the difference between prospective, concurrent, and retrospective risk adjustment?
How does IKS Health keep risk adjustment accurate and compliant?
How does IKS Health integrate risk adjustment into existing clinical workflows without adding provider burden?
How does IKS Health support risk adjustment beyond coding and chart review?
IKS Health offers prospective, concurrent, and retrospective HCC coding, along with clinical documentation improvement, provider education, and risk adjustment audits. Together they cover the full cycle. Conditions are identified before the visit, documentation is validated before the claim is released, and missed diagnoses are recovered after submission. Education and audits then close the gaps that cause repeat errors.
Trusted partner for healthcare organizations
