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.