Capture Every RAF Score. Close Every Gap.
TMS certified HCC coders review charts prospectively and retrospectively to close documentation gaps, improve risk accuracy, and recover revenue you're already entitled to.
Is Your Risk Adjustment Programme Leaving Revenue on the Table?
Most Medicare Advantage plans and ACOs are systematically under-capturing RAF scores — here's why.
Underdocumented HCCs
Chronic conditions documented in clinical notes but never coded as diagnoses, silently dragging RAF scores below their true level.
Annual Resets Without Recapture
HCC codes must be recaptured every year. Without a systematic prospective review programme, compliant codes disappear from your risk score.
Inadequate Chart Review Depth
Relying on claims data alone misses 20–30% of diagnosable chronic conditions present in clinical documentation.
Slow Retrospective Cycles
Late retrospective submissions cost you in reconciliation penalties and reduce the time available to act on prospective gaps before year-end.
How TMS Maximises Your Medicare Risk Accuracy
A full-cycle MRA programme with certified coders, analytics-driven gap identification, and direct EHR integration.
Prospective Chart Review
Pre-visit gap analysis flags undocumented HCCs before appointments so providers can address them at the point of care.
Retrospective Review
Post-encounter chart sweeps capture missed diagnoses and prepare addenda documentation for compliant coding corrections.
HEDIS & Star Ratings
HEDIS gap closure analysis and CAHPS survey support to improve Star Ratings alongside risk adjustment performance.
Direct EHR Integration
We work inside your EHR (Epic, athenahealth, eClinicalWorks, Veradigm) — no new portals, no duplicate workflows for your staff.
Analytics & Reporting
Monthly RAF score trending, gap closure rates by provider, and compliance audit trails available in real time.
CRC & CPC Certified Coders
Every coder holds active CRC or CPC credentials with specific Medicare Advantage training and annual recertification.
Roles We Deploy
Every role is pre-vetted, HIPAA-trained, and ready to integrate into your workflows within two weeks.
Discuss Your Staffing NeedsFrom Contract Signed to Fully Operational in 4 Steps
Data & Gap Analysis
We pull your claims and clinical data to identify members with likely undocumented HCCs and prioritise by revenue impact.
Chart Review
Certified coders review records against CMS HCC v28 guidelines, flagging additions, deletions, and documentation gaps.
Provider Collaboration
Gap closure reports sent to providers with clinical context. Addendum workflows managed by your TMS team.
Submission & Reporting
Corrected codes submitted to your encounter system. Monthly RAF trending and ROI reports delivered to leadership.
Common Questions About Medicare Risk Adjustment
Medicare Risk Adjustment is the process by which CMS adjusts capitation payments to Medicare Advantage plans and ACOs based on the documented health status of their members. Higher RAF (Risk Adjustment Factor) scores reflect sicker members and result in higher payments. Accurate documentation and coding are essential to capturing the correct RAF score.
Hierarchical Condition Category (HCC) codes are a grouping of ICD-10 diagnoses that CMS uses to calculate RAF scores. Only diagnoses from the CMS HCC v28 model count toward risk adjustment. Each HCC must be coded from a face-to-face clinical encounter each calendar year to be included in the RAF calculation.
TMS uses a strictly compliant coding process grounded in documented clinical evidence. We never code beyond what is clinically supported in the record. Our retrospective reviews include addendum request workflows so providers can confirm or document diagnoses they have already assessed but not formally coded.
Our team is trained on Epic, athenahealth, eClinicalWorks, NextGen, Veradigm, Allscripts, Meditech, and most major ambulatory EHR platforms. We request read/write access through your standard IT security process and operate entirely within your existing system.
Most clients see a 15–20% improvement in average RAF scores within the first 6 months of a prospective review programme. Retrospective programmes typically generate 8–14% additional net revenue on reviewed populations. Results vary based on baseline coding quality and member complexity.
Ready to Transform Your Medicare Risk Adjustment?
Join 200+ healthcare organisations that have cut costs, reduced errors, and freed their clinical teams to focus on what matters most — patient care.