Risk Adjustment
Built With Foresight

Risk adjustment succeeds when insight comes before impact. We deliver risk adjustment coding across prospective, concurrent, and retrospective workflows – designed to strengthen HCC coding accuracy, support confident RADV audit performance, and sustain long-term program stability.

Every missed or unsupported diagnosis represents potential revenue left behind and audit risk exposed. Our approach ensures complete, defensible HCC capture while giving your team real-time visibility into patient complexity and RAF impact.

Assess Risk Readiness

When Risk Scores Miss Clinical Reality

Is your risk adjustment coding truly reflecting patient complexity – or leaving value behind?

Risk adjustment coding spans prospective, concurrent, and retrospective programs – yet many risk adjustment services still operate in silos, disconnected from how RAF scores are built, defended, and sustained under scrutiny. As RADV audits accelerate, even minor gaps between documentation, HCC coding, and medical record retrieval can materially impact audit outcomes and long-term performance.

RAF Scores Built Without Audit-Grade Documentation Support

HCC Coding Disconnected From Audit Defensibility Standards

Medical Record Retrieval Lagging CMS RADV Audits Requirements

Risk Adjustment , Reconnected

Risk Adjustment Built Across Clinical, Coding, And Audit Reality

3Gen’s risk adjustment services reconnect documentation, HCC coding, analytics, and audit readiness into a single, workflow-integrated risk adjustment operating model – designed to perform across the full risk lifecycle, not just one moment in time.

Full-Lifecycle Risk Adjustment

Prospective, concurrent, and retrospective risk adjustment aligned to maximize accurate capture.

Coder-Led HCC Chart Review

Expert HCC coding and validation delivered through hybrid AI assisted or all manual models.

Suspect Analytics & Gap Closure

Data-driven identification, tracking, and resolution of missed or unsupported conditions.

Medical Record Retrieval

End-to-end EMR and onsite medical record retrieval supporting audit and coding needs.

RADV & CMS Compliance Support

RADV audit preparation, validation, and response aligned with CMS RADV audit standards.

CERR Submissions & Data Reporting

Medicare CERR submissions, financial trend reporting, and plan-level visibility for actionable insights.

Your Success Story Starts Here

Challenge

Fragmented workflows, delayed medical record retrieval, and inconsistent HCC coding threatened RADV audit readiness.

Solution

3Gen unified risk adjustment coding, medical record retrieval, and audit preparation into a single, defensible framework.

Execution

Specialists closed HCC coding gaps, optimized RAF scores, and streamlined CMS audit validation and response from start to finish.

The Outcome

Organizations regained control, boosted RAF scores, and achieved measurable, defensible risk adjustment results. By unifying workflows and using real-time insights, teams proactively close coding gaps, reduce audit risk, and create streamlined, predictable processes across documentation, coding, and compliance. Results vary by client but consistently reflect high performance.

92%+ Chart Retrieval Completion Rate
98%+ HCC Coding Accuracy Achieved
10:1 Overall Return on Investment

Let’s Create Your Success StoryLet’s Create Your Success Story

The 3Gen Difference

Risk Adjustment Backed by
Clinical & Audit Expertise

Risk adjustment requires more than coding engines. With 3Gen, certified medical risk adjustment coders and compliance specialists work alongside your teams – strengthening risk adjustment coding, supporting RADV audit defense, and ensuring documentation stands up to scrutiny.

Explore Our ApproachExplore Our Approach

The 3Gen Advantage

Risk adjustment performs best when clinical insight, compliance rigor, and workflow intelligence operate together. That’s the alignment 3Gen brings to every engagement.

Real-Time AI + Expert Validation

AI-assisted HCC coding is always verified by certified coders, ensuring precision and clinical confidence.

Proactive Gap Identification

High-risk coding gaps are spotted and resolved before they impact RAF scores or program outcomes.

Integrated Workflow Intelligence

Charts move seamlessly across teams, keeping risk coding complete, compliant, and future-ready.

Performance Visibility & Reporting

Interactive real-time dashboards provide plan- and provider-level insights to guide strategic decisions.

Is Your Risk Adjustment Coding Audit-Ready?

Let’s take a closer look at whether your current medical coding risk adjustment approach is defensible, complete, and future-proof.

Connect with our experts to:

Identify hidden HCC coding risk
Strengthen RAF score sustainability
Prepare confidently for RADV audits

Continue The Journey

Strong risk adjustment coding and audits create momentum – the greatest impact happens when documentation, quality, and billing move forward together.

HEDIS

Precise clinical abstraction that strengthens quality measure performance and Stars outcomes.

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CDI Programs

Documentation programs that improve specificity, consistency, and coding accuracy.

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Audit & Education

Focused audits and education that reinforce compliance and elevate team performance.

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Medical Billing

Integrated medical billing that aligns coding, claims, and reimbursement end to end.

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Explore All Revenue SolutionsExplore All Revenue Solutions

FAQs

Clear answers for complex medical risk adjustment decisions – so you can move forward with confidence.

Talk to An ExpertTalk to An Expert

Risk adjustment coding includes prospective, concurrent, and retrospective risk adjustment workflows designed to accurately capture patient complexity through compliant HCC coding. Effective medical risk adjustment connects documentation, coding, analytics, and medical record retrieval to support sustainable RAF performance and audit readiness.

RADV audits assess whether submitted diagnoses are fully supported by medical records. Gaps in medical coding risk adjustment, documentation, or retrieval can result in recoupments. Strong risk adjustment services align HCC coding, CMS RADV audit standards, and validation processes to reduce audit exposure.

Prospective risk adjustment identifies conditions before encounters, concurrent risk adjustment supports documentation during care delivery, and retrospective risk adjustment validates diagnoses after the fact. A complete risk adjustment audit strategy integrates all three to ensure accuracy, compliance, and continuity across the risk lifecycle.

Medical record retrieval is critical. CMS RADV audits require timely, complete, and compliant records to support reported HCCs. Delays or missing documentation can directly impact audit outcomes, even when coding is correct. That’s why medical record retrieval must be tightly aligned with risk adjustment coding workflows.

No. 3Gen uses AI-assisted workflows to enhance efficiency, but every diagnosis is validated by certified medical risk adjustment coders. This hybrid approach combines technology with expertise to ensure accuracy, consistency, and confidence across all risk adjustment services.

Providers partner with 3Gen because we operate as an extension of their teams – not just a vendor. Our approach integrates risk adjustment coding, HCC validation, RADV CMS audit support, and performance visibility into a single, workflow-driven model that scales with program complexity and regulatory change.