CONSULTING
Many organizations have struggled with getting all their data to pass through the numerous edits imposed by CMS, and this has corresponded to a greater risk of missed reimbursement.
We have an intimate understanding of the CMS rules, guidelines and FAQs. Let our knowledge be your knowledge.
SERVICES:
Prospective HCC Modelling
RADV Audit data insight
RAF score Analysis
Error and Rejection analysis and management
HCC Reconciliation and discrepancy management
Data quality metrics
BENEFITS:
Increase transparency in your members RAF score data
Reduce errors and increase accuracy and compliance
Reduce administrative time and resources involved with CMS submissions
Eliminate the need to manage and staff dual processes during the transition period
Increase automation and efficiency
Consulting Services
Expert Guidance for Medicare, Medicaid & ACA Risk Adjustment
Risk adjustment is complex—and every missed detail can mean missed revenue. Many organizations struggle to get their encounter data through CMS edits and validations, leading to errors, rejections, and lost reimbursements.
At Health Data Max, our consulting team brings deep expertise in CMS rules, guidelines, and FAQs to help you navigate these challenges. We translate regulatory complexity into clear, actionable strategies so your organization can stay compliant and profitable.
Our Services
🔹 Prospective HCC Modeling
Forecast risk scores and identify high-impact members before the submission cycle closes.
🔹 RADV Audit Support & Data Insights
Audit-proof your submissions with defensible documentation and advanced analytics.
🔹 RAF Score Analysis
Gain visibility into member- and provider-level RAF performance to protect revenue.
🔹 Error & Rejection Management
Analyze and resolve recurring CMS submission errors to improve acceptance rates.
🔹 HCC Reconciliation
Detect discrepancies between claims and chart data to ensure accurate HCC capture.
🔹 Data Quality Metrics
Measure and improve encounter data integrity with standardized benchmarks.
Key Benefits
✔ Transparency – Full visibility into RAF scores, coding gaps, and submission outcomes
✔ Accuracy & Compliance – Reduce errors and ensure CMS-aligned submissions
✔ Efficiency – Cut administrative time and manual rework with expert guidance
✔ Scalability – Eliminate the need for dual processes during transitions
✔ Automation-Ready – Prepare your workflows for integration with AI-enabled tools
✨ With HDM Consulting, you don’t just meet CMS requirements—you master them.
📩 [Contact Us Today] to learn how our experts can maximize your reimbursement and simplify your compliance.