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Capture the Complete Patient Story. Optimize RAF Scores.
Advanced HCC Coding and Risk Adjustment solutions that align clinical reality with financial reimbursement. Bridging the gap between Fee-For-Service and Value-Based Care.Capture the Complete Patient Story. Optimize RAF Scores.
THE SHIFT TO VALUE-BASED CARE
THE SHIFT TO VALUE-BASED CARE
Accuracy is the New Currency
At Neelam Enterprises & Infotech Solutions, we understand that a missing chronic condition code doesn't just mean lost revenue; it means a failure to capture the true health status of a patient. Our specialized HCC coders ensure that every diagnosis is captured, documented, and compliant.Accuracy is the New Currency
OUR HCC CODING METHODOLOGY
OUR HCC CODING METHODOLOGY
The "M.E.A.T." Criteria Experts
We don't just code from a list. We scour the medical record for evidence. For an HCC code to be valid, we ensure the documentation meets the M.E.A.T. standard:The "M.E.A.T." Criteria Experts
- Monitor (Signs, symptoms, disease progression)
- Evaluate (Test results, medication effectiveness)
- Assess (Ordering tests, discussion, records review)
- Treat (Medications, therapies, procedures)
OUR SERVICES
OUR SERVICES
Comprehensive Risk Adjustment Lifecycle
Comprehensive Risk Adjustment Lifecycle
We offer a holistic approach to Risk Adjustment, ensuring you are covered at every stage of the patient journey.
1. Retrospective Chart Reviews (The Cleanup)
1. Retrospective Chart Reviews (The Cleanup)
- What we do: We audit prior year encounters to identify captured vs. uncaptured diagnoses.
- Benefit: We find "dropped" chronic conditions (like Diabetes with Complications, COPD, CHF) that were documented but never coded, recovering significant revenue.
2. Prospective Risk Assessment (The Preparation)
2. Prospective Risk Assessment (The Preparation)
- What we do: Before the patient visits the doctor, we analyze their history and flag "Suspect Conditions" for the physician to evaluate.
- Benefit: Empowers the doctor to address chronic gaps during the visit, improving care quality and documentation in real-time.
3. Concurrent Coding (The Real-Time Fix)
3. Concurrent Coding (The Real-Time Fix)
- What we do: Reviewing charts within 24-48 hours of the visit to correct coding errors before the claim is submitted.
- Benefit: drastic reduction in claim re-submissions and denials.
COMPLIANCE & RADV AUDIT SUPPORT
COMPLIANCE & RADV AUDIT SUPPORT
Audit-Proof Your Revenue
The biggest risk in HCC coding is the RADV (Risk Adjustment Data Validation) Audit. Over-coding can lead to massive fines.Audit-Proof Your Revenue
- The Neelam Shield: We don't just look for missing codes (Upsides); we actively identify and delete incorrect codes (Downsides).
- Validation: If the documentation doesn't support the code, we don't bill it. Period.
- Confidence: We maintain a 98%+ accuracy rate, keeping you safe from CMS penalties.
WHY NEELAM ENTERPRISES?
WHY NEELAM ENTERPRISES?
Technology Meets Human Intelligence
While we utilize futuristic NLP (Natural Language Processing) tools to scan charts, every final code is validated by a human expert.Technology Meets Human Intelligence
- AAPC Certified Risk Adjustment Coders (CRC).
- Expertise in all models: CMS-HCC (Medicare), HHS-HCC (Commercial), and RxHCC.
- Seamless EMR Integration: We work directly within your Epic, Cerner, Allscripts, or eClinicalWorks environment.
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