AAAMB Adds HCC Risk Adjustment Coding Service for Medicare Advantage Practices

United States 8/26/2026 AAA Medical Billing (AAAMB) today announced HCC risk adjustment coding services for practices carrying Medicare Advantage volume, timed to a payment year in which the CMS-HCC Version 28 model applies at one hundred percent for the first time.

The service covers chart review, documentation support, condition recapture tracking, and audit readiness for practices in Medicare Advantage arrangements. It is offered to practices in shared risk and value-based contracts as well as to those billing Medicare Advantage under standard fee-for-service terms.

Why the Timing Matters

CMS phased Version 28 in over three payment years, running it alongside the older Version 24 model at a shifting ratio. Payment year 2026 uses Version 28 alone, which removes the cushion that softened the change for practices still coding to older habits.

The model itself is narrower in some respects and broader in others. The count of diagnosis codes that map to a payment category dropped substantially from the prior model, while the number of payment categories grew. A practice can code as carefully as it did last year and still see risk scores fall, because codes that carried weight under the old model no longer do.

Audit activity moved in the same direction over the same period. Risk Adjustment Data Validation reviews test submitted diagnoses against the medical record, and findings can now be extrapolated across a contract rather than limited to the sampled charts. A single unsupported code in a sample can drive a recovery well beyond the value of that code.

An AAAMB executive said, “The model change and the audit change landed in the same year. Practices that used to treat risk adjustment as a coding exercise are finding out it is a documentation exercise, and the record is what gets reviewed.” 

What the Service Covers

The service is built around the record rather than around finding additional diagnoses to submit.

Chart Review in Both Directions

Reviews look for conditions that were treated during the year and never coded, and equally for conditions still being coded after they are resolved. The second category is the one most programs skip, and it is the one auditors pull first.

A chronic condition carried forward on a problem list and coded as active while the record shows it cleared is a straightforward audit finding. Removing unsupported codes lowers a risk score, and it removes the part of that score most exposed to recovery.

Documentation Support for Clinicians

Most gaps come from conditions that were genuinely managed and written up in a way that does not show the management. The service provides documentation prompts built around the standard reviewers apply, which looks for evidence that a condition was monitored, evaluated, assessed, or treated during the encounter.

Support is designed to fit existing clinical workflow rather than add steps to it, since documentation programs that lengthen the visit tend not to survive contact with a full schedule.

Recapture Tracking

Risk adjustment operates on a calendar year, and conditions do not carry forward. Every chronic condition a patient carries has to be addressed and coded again each year with current support in the record.

The service tracks which patients with chronic conditions have not yet had a qualifying encounter, so outreach happens during the year rather than in a December scramble. Practices that rely on the problem list to carry this work forward generally find at year end that much of it was never coded.

Encounter & Audit Readiness

Reviews confirm the structural elements that invalidate records regardless of clinical quality, including face-to-face encounter requirements, acceptable provider type, signature and credential completeness, and correct patient and date of service.

“A lower score that the record fully supports is a better position than a higher score that comes apart under review. We would rather a client defend everything they submitted.” 

How the Service Is Delivered

Practices begin with a baseline review of a sample of encounters, which identifies where documentation supports the codes submitted and where it does not. That review sets the scope of ongoing work.

Ongoing service can run prospectively, with review before submission, or retrospectively across submitted claims, or both. Prospective review is generally recommended where the workflow allows it, since correcting a note before submission is far simpler than defending it afterward.

Reporting covers recapture rates for chronic conditions, the share of unspecified codes where a specific option exists, signature and credential completeness, and conditions coded without qualifying encounter support.

Practices in shared risk arrangements receive reporting mapped to the contract terms they are measured against, since the value of a documentation gap depends on how a given agreement converts risk scores into payment. Practices billing Medicare Advantage without shared risk receive the same review work with reporting focused on audit exposure rather than on score movement.

Availability

The HCC risk adjustment coding service is available now to practices across the United States, in both shared risk and standard Medicare Advantage arrangements.

Engagements begin with the baseline sample review described above, which sets the scope of ongoing work and the pricing that follows from it. Practices can start with retrospective review of submitted claims and move to prospective review as documentation workflow allows, or run both from the start.

Practices interested in the service can request a baseline review through the AAAMB website or by contacting the company directly.

About AAA Medical Billing

AAA Medical Billing (AAAMB) is a medical billing and revenue cycle management company headquartered in Flushing, New York. The company provides billing, coding, credentialing, eligibility verification, denial management, patient collections, appointment scheduling, and practice management services to healthcare providers across the United States, along with durable medical equipment billing and technology products for charge capture, credentialing, and order intake.

More information is available at https://aaamb.com. 

Media Contact

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