Why LexiCode for Risk Adjustment?
Our approach makes risk adjustment clear and manageable. With purpose-built tools, expert guidance, and specialty-specific insight, LexiCode helps organizations achieve RAF accuracy while staying audit-ready at every turn.
- Spot Trends Before They Impact Revenue
- Validate Risk Across Care Settings
- Protect Long-Term Compliance
What Sets LexiCode Apart?
Accuracy in risk adjustment relies on both advanced tools and experienced personnel. At LexiCode, we bring them together so RAF scores reflect patient complexity with precision and compliance built in.
Our technology surfaces documentation gaps, care patterns, and population-level risk. Every finding is reviewed by credentialed coders and nurses who understand CMS models and the financial impact behind each decision.
With real-time visibility and predictive insights, you know where your risk stands, how it’s evolving, and what to address before audits or recoupments appear. It’s a clear path to stronger outcomes.
Our model includes:
- Full CMS model integration for HCC and RAF scoring
- Dashboards that track deficiencies and care gaps in real time
- Claims-based analytics for actionable population insights
- CDI reviews guided by credentialed experts
- Forecasting that anticipates the end-of-year RAF performance
- Workflows tailored to your organization’s needs
Results That Speak for Themselves
98% Coding Accuracy
10–12% Revenue Growth
35–40% Reduction in Overhead
Your Strategy for Smarter Risk Adjustment
Every encounter contains value that should be recognized. LexiCode transforms claims and clinical notes into prioritized tasks, enabling clinicians to capture the diagnoses that matter most for RAF, while leaders receive the necessary metrics to take action.
Our Core Risk Adjustment Capabilities Include:
Comprehensive Risk Analytics
A powerful scoring engine that incorporates all CMS risk models and logic to deliver reliable patient and population insights.
Continuous Data Monitoring
Dashboards that highlight documentation shortfalls, patient no-shows, and care gap populations while tracking risk recapture over time.
Forecasting and Planning
Predictive analysis that measures year-end RAF potential and pinpoints where to focus resources for the greatest impact.
Clinical Documentation Support
Specialized nurse and coding teams provide concurrent and pre-visit reviews to ensure accurate documentation and coding.
Education for Providers
Practical feedback and training are designed to help clinicians document thoroughly and sustain long-term improvement.
Targeted Audit Programs
Audit strategies that prepare your organization for CMS reviews and deliver measurable insights on RAF scores and revenue impact.
LexiCode’s Risk Adjustment services are trusted for their accuracy, depth, and ability to deliver lasting results across both hospital and physician practice settings.
How Our Risk Adjustment Services Strengthen Compliance and Revenue
Effective risk adjustment depends on consistent processes that connect data, documentation, and coding accuracy. LexiCode’s services provide a structured framework that helps organizations strengthen compliance, refine RAF scoring, and plan confidently for value-based care.
Step
1
Establishing the Risk Baseline
We begin with claims-based data analysis and our Risk Score Engine, which applies all CMS models to deliver a reliable snapshot of patient and population risk.
Step
2
Identifying Gaps and Opportunities
Through real-time dashboards, we surface documentation deficiencies, patient no-visits, and care gap populations that affect RAF scores.
Step
3
Strengthening Documentation and Coding
Our nurse and coder teams conduct concurrent and pre-visit reviews to ensure accurate ICD-10 coding, full HCC capture, and strong CDI alignment.
Step
4
Engaging and Educating Providers
We deliver targeted provider feedback and education designed to build sustainable documentation practices that improve RAF accuracy over time.
Step
5
Forecasting and Preparing for Audits
Predictive analytics model potential year-end gaps, while our tailored audits measure pre- and post-audit RAF impact and ensure CMS compliance.
Specialized Medical Coding Solutions for Every Care Setting
Every care setting brings its own set of coding complexities, and LexiCode meets them all with unmatched accuracy.
Hospital Inpatient & outpatient
We deliver accurate coding for all types of inpatient admissions and outpatient procedures, helping hospitals maximize reimbursement while minimizing the risk of denials
Physician Offices & Clinics
From routine checkups to specialty visits, our coders apply the latest guidelines across all CPT and ICD-10-CM codes to support timely billing
Emergency Departments
High volume doesn’t have to mean high error rates. LexiCode coders thrive in high-pressure ED settings with fast, accurate code assignment and real-time edit resolution
Home Health & Skilled Nursing Facilities
Surgical coding accuracy is critical. Our team is trained in ASC-specific APC groupings and modifier use to ensure proper payment every time
Our Award-Winning Expertise
Explore our gallery of awards and milestones that recognize our contributions to improving healthcare quality and performance.
NelsonHall
NelsonHall’s Healthcare Payer Operational Transformation NEAT Vendor Evaluation 2023
Everest Peak Matrix
PEAK Matrix® for Medical Coding Operations 2022
Everest Peak Matrix
PEAK Matrix® for Intelligent Automation Healthcare 2022
HI TRUST CSF Certification
FAQS
Frequently Asked Questions
What Risk Adjustment services does LexiCode provide?
We offer a complete suite of Risk Adjustment solutions, including RAF analytics, clinical documentation integrity (CDI) support, provider education, and customized audit programs. Our services are designed for both hospital-based and physician practice settings.
How does LexiCode help improve RAF scores?
We use a comprehensive Risk Score Engine that incorporates all CMS models to analyze aggregated claims data and stratify patients by condition, provider, and setting. Our dashboards highlight documentation gaps, missed visits, and care gaps, enabling organizations to take targeted action to improve RAF outcomes.
What role do your clinical experts play?
Our nurse and coder teams conduct concurrent and pre-visit CDI reviews to ensure accurate documentation and complete ICD-10 coding. They also provide ongoing provider feedback and education, which is critical for sustaining long-term RAF improvement.
Can LexiCode help with compliance and audit readiness?
Yes. We design customized audit plans that include pre- and post-audit RAF scoring, reimbursement impact assessments, and CMS reporting preparedness. This helps organizations reduce compliance risk and strengthen revenue integrity.
How does LexiCode use data without risking patient privacy?
Our analytics are powered by aggregated claims data only, so no PHI is required. This ensures that organizations gain population-level insights while maintaining full compliance with privacy and security standards.
How do I get started with LexiCode’s Risk Adjustment Services?
Reach out to us for a customized plan. We’ll assess your current processes, identify opportunities for improvement, and recommend a risk adjustment strategy tailored to your organizational goals.
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