BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM CARC
🟢 Risk Adjustment Coding Services
Drive Revenue with Accurate Risk Adjustment Coding
Dedicated to Delivering High-Quality Risk Adjustment Coding
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Total Appointments Scheduled
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120
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Overview
Hierarchical Condition Categories (HCC) Coding Expertise
From prospective and concurrent reviews to targeted chart evaluations and advanced validation processes, each method plays a crucial role in improving coding accuracy and aligning with regulatory requirements
Coding using Hierarchical Condition Categories (HCC)
Our certified coding specialists focus on HCC coding, precisely recording patient conditions to represent their actual health status and risk ratings.
Chart Reviews and Data Validation
We thoroughly evaluate patient charts and data to identify missing or inaccurate diagnoses.
Advanced Workflow Technologies
We employ cutting-edge workflow management technologies to expedite turnaround times, increase efficiency, and simplify coding
Auditing and Compliance Services
We employ cutting-edge workflow management technologies to expedite turnaround times, increase efficiency, and simplify coding
Tailored data and Analytics
We provide in-depth data and analytics to help you comprehensively understand your risk adjustment performance
Operations
Comprehensive Risk Adjustment and Coding Quality Services
ASP-RCM coders deliver accurate, compliant risk adjustment coding that meets client expectations. We follow current CMS and HHS guidelines, use strict quality checks, and ensure all codes are backed by proper documentation. Our process helps clients improve RAF scores, reduce audit risk, and get reliable financial projections. We focus on complete, correct coding—nothing missed, nothing unsupported.
Prospective Reviews
At ASP-RCM, our coders conduct prospective reviews before patient visits to flag potential risk adjustment opportunities. We review historical data, identify missing chronic conditions, and highlight suspect diagnoses that require provider validation. What sets us apart is our ability to combine coding expertise with clinical insight, ensuring providers are prepared to document conditions accurately during the encounter. This proactive approach helps close gaps, improve capture rates, and support stronger RAF scores.
Concurrent Reviews
While care is underway, we monitor documentation in real time to keep coding aligned with the evolving clinical picture. ASP-RCM works side by side with care teams to validate diagnoses, capture emerging conditions, and meet payer requirements before discharge. This live oversight keeps revenue secure, reduces denials, and ensures claims are accurate the first time.
Retrospective Reviews
After the encounter, our team conducts a thorough review to catch what others overlook. ASP-RCM analyzes records for missed diagnoses, incomplete documentation, and risk adjustment opportunities—well before claims or audits create exposure. The result: corrected records, maximized reimbursement, and a complete clinical story backed by compliance confidence.
Targeted Chart Reviews
When a specific diagnosis, condition, or service is in question, ASP-RCM zeroes in. Our targeted chart reviews focus on high-impact areas—like chronic conditions, complex procedures, or documentation flagged for payer scrutiny. By addressing only what matters, we deliver fast, accurate insight that strengthens claims and reduces the risk of denials.
Comprehensive Chart Reviews
We check everything to get a whole picture. The thorough reviews conducted by ASP-RCM examine every patient record, noting all diagnoses, verifying paperwork, and guaranteeing correct coding for each encounter. A fully optimized chart that promotes clinical integrity, audit preparedness, and proper reimbursement is the end result.
Focused Encounter Reviews
High-stakes encounters demand precision. ASP-RCM zeroes in on visits like Annual Wellness and hospital admissions, validating documentation, confirming coding accuracy, and addressing gaps before claims go out the door. The result: protected revenue, fewer denials, and compliance locked in from the start.
Risk Adjustment Data Validation (RADV) Reviews
RADV reviews leave no room for error. ASP-RCM applies the same scrutiny payers use—verifying every coded diagnosis against the medical record. We pinpoint weak spots, correct inconsistencies, and equip providers to defend their risk adjustment data with full confidence.
HCC Suspecting Reviews
Identifying potential risk conditions before they impact scores is where ASP-RCM excels. Our HCC suspecting reviews leverage patient history and clinical patterns to flag likely chronic conditions that may be under-documented. This ensures providers have the insight needed to confirm, document, and capture risk accurately.
Quality Assurance Reviews
Strong claims start with airtight processes. ASP-RCM’s quality assurance reviews audit coding accuracy, verify documentation, and ensure compliance with CMS and industry standards. This final checkpoint protects revenue, prevents costly rework, and keeps your organization audit-ready year-round.
Dual Coding Reviews
For critical encounters, ASP-RCM assigns two independent coding teams to review the same record. Every code is verified for accuracy, every discrepancy resolved. This extra layer of scrutiny elevates coding precision, reinforces compliance, and strengthens payer confidence.
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have safely received your patient and encounter data, we code, review, and send claims to payers. We also manage appeals and denials, track payments, and provide frequent updates. Our procedure is designed to be effective and open.
Our qualified coders and billing specialists evaluate every claim stringently. We employ quality control procedures, coding audits, and cross-referencing with payer requirements to guarantee accuracy and lower the possibility of denials.
Our denial management team examines every refused claim to identify the underlying reason. We quickly fix any problems and submit claims again, and where needed, we collaborate with payers on appeals to ensure you get the most money back.
Our pricing policy is adaptable and customized to meet every customer's demands. Usually, we charge a set fee based on volume or a portion of collections. Contact us for a quote tailored to your clinic's particular needs.
Indeed. Our specialty is smooth transfers from internal procedures or other billing businesses. To guarantee that all data is moved safely, our staff will collaborate closely with you and offer training as required.
Resources
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