Jacobus Consulting


Risk Adjustment Services for the Medicare Advantage Program

Hierarchical Condition Categories (HCC) lie at the heart of CMS payment models for the Medicare Advantage programs.

HCC codes allow payments to be risk-adjusted based on the history and complexity of a patient’s health. And, from this, Risk Adjustment Factor (RAF) scores are created which shape capitated reimbursement on a per-member basis. With the rapid rise of enrollees in the Medicare Advantage Program, accurate HCC coding has never played a more important role in the workflow of physicians and clinical staff.

Further, accurate HCC coding helps to create more holistic pictures of the complexity of a patient population, improves the value of problem lists, and enables better management of a patient’s chronic conditions. Better documentation that captures the full complexity of the patient often results in appropriately higher reimbursement. This is where Jacobus Consulting can help.

Using our team of Clinical Navigators and Physician Advisors along with a simple-to-use and minimally disruptive tool, Jacobus Consulting has helped some of the most prestigious providers and health plans assess current states, discover opportunities to improve workflows, and implement processes that yield high ROI results.

Jacobus Consulting has helped providers and health plans:

  • Uncover hidden revenue upwards of $1M+
  • Capture accurate HCC coding specificity with minimal workflow disruption
  • Discover new diagnoses and implement new and regular screening practices
  • Increase physician and staff adoption, communication, and coordination of standardized coding practices
  • Achieve risk-adjusted reimbursement and meet CMS national benchmarks
  • Increase clarity in problem list management

Using a unique just-in-time methodology and a simplified communication tool, your organization can realize significant improvements in HCC coding accuracy, revenue and reimbursement, and staff adoption.

To learn how we can help your organization, contact us. See how one client improved Risk-Adjusted Reimbursement.