RISK ADJUSTMENT CODING
HCC & RAF Optimization
Experts
Experts
SunRCM delivers accurate, compliant, and clinically validated Risk Adjustment Coding (HCC) services with AAPC/AHIMA certified coders and doctors/nurses as auditors. Trusted by Invent Health, Edifecs, and Wipro.
Our Expertise in Risk Adjustment Coding
Risk Adjustment (HCC) coding is more than assigning diagnosis codes — it's about identifying the true clinical complexity of each patient. Our coders, equipped with domain expertise and AI-driven tools, capture every chronic condition with precision.
✔HCC Coding for CMS-HCC, HHS-HCC, ESRD, and PACE models
✔Clinical Indicator Validation (Lab, Imaging, Medication, Assessment)
✔MEAT Validation (Monitor, Evaluate, Assess, Treat)
✔RADV Audit Preparation and Support
✔Concurrent, Retrospective, and Prospective Chart Reviews
✔Chronic Condition Capture and Documentation Improvement
✔AI-Based Diagnosis Identification and Gap Analysis
Clinical Indicator Validation
Unlike generic coding vendors, SunRCM integrates clinical auditing into every project. Each diagnosis code is cross-verified with clinical indicators.
1
The condition is actively managed
2
Documentation supports clinical relevance
3
MEAT elements are clearly established
4
Each HCC is accurately linked to provider documentation
OUR PROCESS
Our Risk Adjustment Process
A systematic approach to ensure accuracy, compliance, and audit readiness
01
Chart Collection & Indexing
Secure data retrieval through HIPAA-compliant channels
02
AI-Assisted Pre-Review
NLP-based tools identify chronic conditions and missing HCCs
03
Coder Review & HCC Mapping
AAPC/AHIMA-certified coders assign accurate ICD-10-CM codes
04
Clinical Indicator Validation
Doctors and nurses validate findings, labs, and assessments
05
MEAT & Documentation Review
Each diagnosis justified using CMS MEAT framework
06
Dual QA and Audit Layer
Independent quality audit to ensure 98-99% accuracy
07
Final Delivery & Reporting
Comprehensive summary with RAF, HCC distribution, and QA metrics
OUR TEAM
Experienced Team, Clinical Excellence
Each member undergoes continuous education and AI tool training for precision and productivity
AAPC / AHIMA Certified Coders
CRC, CPC, CCS, CAIMC, and FIMC professionals
Doctors and Nurses as Auditors
Expert reviewers ensure medical necessity and clinical accuracy
HCC Project Managers
Experience in Medicare Advantage, ACA, and Commercial risk models
Quality Analysts
Ensure consistent compliance with CMS and OIG guidelines
WHY SUNRCM
Why Choose SunRCM for Risk Adjustment Coding?
Leadership That Inspires Confidence
Founded by Dr. Meriyala Santosh Kumar Guptha, a world record holder with 21+ years of U.S. healthcare experience.
Trusted by Industry Leaders
Proud partners of Invent Health, Edifecs, and Wipro — 99% coding accuracy, 0% RADV rejections.
Clinical + Coding Integration
Every code we assign is clinically justified. Our dual-layer team ensures audit-ready data.
Technology Meets Human Intelligence
AI-driven review platforms integrated with human coders for maximum efficiency.
Complete Compliance and Confidentiality
HIPAA, GDPR, and OIG guidelines with robust data security and encryption.
Leadership Excellence
Forbes-listed "Pride of India" company with TEDx-recognized leadership.
SPECIALTIES
Specialties We Support for Risk Adjustment
Our team covers every major chronic care specialty
Cardiology
Pulmonology
Endocrinology
Nephrology
Oncology
Rheumatology
Psychiatry
Neurology
Orthopedics
Gastroenterology
Urology
Geriatrics
Primary Care
Family Medicine
Internal Medicine