Risk Adjustment
Risk Adjustment Coding (HCC)
Complete, compliant HCC capture for Medicare Advantage and value-based care — so your risk scores and capitation payments are exactly right.
Reviewed for clinical and coding accuracy by Zyphercode’s AHIMA- and AAPC-certified coding leadership.
100%
Audit-ready charts
99%+
Coding accuracy
RADV
Validation ready
Overview
In value-based and Medicare Advantage programs, accurate risk adjustment is the difference between sustainable margins and left-on-the-table revenue. Our certified risk-adjustment coders perform thorough chart reviews to capture every supported HCC while rigorously avoiding unsupported codes.
We run prospective, concurrent, and retrospective reviews, supported by RADV-style audit readiness, so your RAF scores accurately reflect member acuity and your program stands up to payer and CMS scrutiny.
What we deliver
Capabilities built for results
CRC-certified coders
Risk-adjustment specialists trained on CMS-HCC and HHS-HCC models.
Full review spectrum
Prospective, concurrent, and retrospective chart reviews tailored to your program.
RADV audit readiness
Documentation and coding that withstand CMS validation audits.
Suspect & gap analytics
Identify undocumented conditions and recapture opportunities.
Why Zyphercode
The outcomes you can expect
We pair specialized expertise with disciplined delivery and transparent reporting — so the value shows up in your numbers, not just in a deck.
Schedule a conversation- Accurate RAF scores and capitation payments
- Reduced compliance and over-coding risk
- Recaptured chronic conditions year over year
- Audit-ready documentation and trails
- Clear analytics on gaps and suspects
- Scalable capacity for AEP and sweeps
FAQ
Common questions
What is HCC risk adjustment coding?
HCC (Hierarchical Condition Category) coding captures chronic and serious diagnoses to calculate a patient's risk score (RAF), which determines appropriate reimbursement under Medicare Advantage and value-based care programs.
Are your risk adjustment coders CRC-certified?
Yes. Our risk-adjustment specialists are AAPC CRC-certified and trained on both the CMS-HCC and HHS-HCC models.
Can you support RADV audits?
Yes. Our documentation and coding are RADV audit-ready, designed to withstand CMS validation reviews.
What types of chart review do you offer?
We run prospective, concurrent, and retrospective chart reviews, plus suspect and gap analytics to recapture chronic conditions year over year.
Ready to get started with Risk Adjustment Coding (HCC)?
Let's talk about your goals and how Zyphercode can deliver measurable results.
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