At 3Gen Consulting, we specialize in risk adjustment coding services that help Accountable Care Organizations (ACOs), Medicare Advantage plans, and U.S. healthcare providers thrive in a value-based care environment. Our team of certified risk adjustment coders blends deep clinical knowledge with AI-driven precision to deliver compliant, audit-ready HCC coding – at scale.
Our tech-enabled service model supports:
- RAF score optimization to reflect true patient risk
- Prospective, concurrent, and retrospective coding reviews
- Documentation gap closure and EHR-integrated workflows
Powered by RiskGen-i, our proprietary AI platform, we help you code smarter, act faster, and get reimbursed accurately.
RiskGen-i is our proprietary AI platform built specifically for HCC medical coding and risk adjustment management. By combining advanced OCR, natural language processing (NLP), and machine learning, RiskGen-i helps our certified coders:
AI doesn’t replace our experts — it supercharges them. Every chart is still reviewed by our CPC-CRC certified coders, ensuring clinical validity, compliance, and audit-readiness. That’s the difference between generic automation and tech-enabled expertise.
Level 1: AI/NLP Coding Engine
Level 2: CPC-CRC Certified Coder
Level 3: Senior CPC-CRC Specialist
Level 4: QA Audit Review
We analyze historical diagnoses, prescriptions, lab results, and encounter notes to identify high-value HCC codes before the patient visit. Our certified risk adjustment coders create a shortlist of potential diagnoses — giving providers a smarter, faster starting point for documentation and care planning.
Why it matters: Capture the right codes during the encounter, improve accuracy from the outset, and inform better care plans.
Our coders conduct real-time chart reviews before claims are submitted, validating HCC accuracy and ensuring alignment with current-year RAF scoring models. This reduces claim errors and accelerates reimbursement timelines.
Why it matters: Cleaner claims, faster payments, fewer denials, and peace of mind for your coding team.
After claims are submitted, we review medical records to identify missed HCCs or unsupported diagnoses. This supports ongoing improvement in documentation practices and helps recover lost revenue from under-coded encounters.
Why it matters: Recover missed revenue, uncover coding gaps, and strengthen compliance controls.
We support Clerical Error Reopenings (CERR) for ACOs and provider organizations — submitting corrections to Medicare Administrative Contractors (MACs) which will impact RAF scores and secure rightful reimbursement.
Why it matters: Don’t leave revenue on the table due to coding oversights – we help you fix errors post-submission, fast.
We provide custom dashboards and real-time reports to help Medicare Advantage plans, providers, and ACO leadership monitor RAF trends, measure coder productivity, and make strategic decisions.
Why it matters: Visibility drives value. See your coding’s impact on risk scores, care gaps, and reimbursement performance – all in one place.
With four levels of review and 98%+ coding accuracy, we ensure every chart meets the highest standards — and stands up to CMS or MAC audits.
RiskGen-i supercharges our coders with OCR, NLP, and ML — helping surface the right HCCs, spot gaps, and speed up reviews by 10x.
Every chart is reviewed by CPC-CRC certified risk adjustment coders, backed by seasoned auditors and QA specialists who live and breathe coding compliance.
HIPAA, CMS, RAF scoring logic — we build compliance into every step of our workflow, so your team doesn’t have to second-guess documentation.
Whether you’re reviewing 1,000 or 100,000 charts, our flexible, tech-enabled service model scales with you — without the overhead or stress.
Prospective coding happens before the patient visit and can provide key information prior to patient visits. Concurrent reviews are done before claims go out to ensure accuracy and prevent rework. Retrospective coding occurs after submission to catch missed HCCs or documentation gaps. Most organizations benefit from a hybrid approach — and we help tailor it based on your population and goals.
Not if you care about compliance. While AI platforms like RiskGen-i dramatically improve speed and surface HCC opportunities, they work best with certified risk coders. At 3Gen Consulting, every chart goes through layered human review to ensure clinical logic, MEAT/TAMPER standards, and audit readiness are met.
Common pitfalls include unsupported diagnoses, upcoding, and incomplete documentation. CMS and MACs are increasingly scrutinizing RAF scores and HCC submissions. Our 4-tier QA model is designed to flag these risks early — reducing denials, minimizing corrections, and keeping you audit-ready.
Look for three things: proven coders (CPC-CRC certified), scalable tech (like RiskGen-i), and a multi-level quality control process. Bonus points for organizations that offer services like CERR submission, provider education, and real-time analytics — like 3Gen.
Improving RAF score accuracy starts with complete, timely, and clinically justified documentation. You’ll want to capture all chronic conditions annually, meet MEAT or TAMPER criteria, and ensure proper HCC mapping. At 3Gen Consulting, our tech-enabled approach combines AI-powered HCC detection with human validation — so your RAF scores reflect true patient risk and reimbursement potential.
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