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About Us

about us

Serving Healthcare
Providers for Over 8 Years

Helping hospitals and clinics achieve financial accuracy and operational excellence. At HealthGrade Solutions, we are dedicated to delivering precision and excellence in healthcare auditing and validation to help our clients thrive.

8 Years

  • In Business

Trusted

  • By hospitals & clinics

Serving

  • Rural Hospitals

HealthGrade Solutions specializes in providing comprehensive services in medical outpatient HCC coding and inpatient DRG validation auditing. Here are key highlights of its offerings:

01

Medical Outpatient HCC Coding

  1. Risk Adjustment Coding: Expertise in capturing Hierarchical Condition Categories (HCC) codes to ensure accurate risk score calculations for outpatient settings.
  2. Compliance and Accuracy: Adherence to CMS guidelines and other regulatory requirements to prevent over- or undercoding.
  3. Data-Driven Solutions: Utilizes robust technology and analytics to enhance coding precision and reduce errors.
  4. Provider Education: Offers education and training to healthcare providers for better documentation practices.

02

Inpatient DRG Validation Auditing

  1. DRG Validation: Ensures the accurate assignment of diagnosis-related groups (DRGs) for hospital inpatient claims, verifying both principal and secondary diagnoses.
  2. Clinical Documentation Integrity (CDI): Works to improve clinical documentation to reflect the true severity of illness and resource utilization.
  3. Revenue Integrity: Helps reduce compliance risks and optimize reimbursements by identifying potential inaccuracies in coding and billing.
  4. Retrospective and Concurrent Reviews: Conducts audits for claims both pre- and post-submission to ensure optimal financial outcomes and regulatory compliance.

03

Medical Outpatient HCC Coding

  1. Risk Adjustment Coding: Expertise in capturing Hierarchical Condition Categories (HCC) codes to ensure accurate risk score calculations for outpatient settings.
  2. Compliance and Accuracy: Adherence to CMS guidelines and other regulatory requirements to prevent over- or undercoding.
  3. Data-Driven Solutions: Utilizes robust technology and analytics to enhance coding precision and reduce errors.
  4. Provider Education: Offers education and training to healthcare providers for better documentation practices.

04

Inpatient DRG Validation Auditing

  1. DRG Validation: Ensures the accurate assignment of diagnosis-related groups (DRGs) for hospital inpatient claims, verifying both principal and secondary diagnoses.
  2. Clinical Documentation Integrity (CDI): Works to improve clinical documentation to reflect the true severity of illness and resource utilization.
  3. Revenue Integrity: Helps reduce compliance risks and optimize reimbursements by identifying potential inaccuracies in coding and billing.
  4. Retrospective and Concurrent Reviews: Conducts audits for claims both pre- and post-submission to ensure optimal financial outcomes and regulatory compliance.

These specialties position HealthGrade Solutions as a strategic partner for healthcare providers aiming to enhance coding accuracy, improve compliance, and optimize revenue cycles.

Our Company

Meet Our Team

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Arlene McCoy

UI/UX Designer

Devon Lane

Frontend Developer

Jerome Bell

Frontend Developer

Testimonials

Leading in Client Satisfaction

Improved Compliance and Accuracy

HealthGrade Solutions has been a game-changer for our rural hospital. Their meticulous auditing uncovered discrepancies we didn’t even realize existed.

Dr. Emily Carter

Director of Operations

Expertise You Can Trust

As a large outpatient clinic, we’ve struggled to keep up with capturing all HCC codes and compliance requirements. HealthGrade solutions provided the expertise we needed to streamline our process and increase our RAF scores.

Michael Thompson

Administrator

Expertise You Can Trust

I have been working at HealthGrade Solutions, LLC for over six months as a risk adjustment coder, and my experience has been nothing short of excellent. The company provides a supportive and flexible work environment, allowing for a great work life balance. Their commitment to accuracy and integrity in medical coding has helped me refine my skills in reviewing and assigning appropriate diagnosis codes. HealthGrade Solutions fosters professional growth and values its employees, making it a fantastic place to work. I truly appreciate the opportunity to be part of a team that prioritizes quality and efficiency in risk adjustment coding.

Andrews

Testimonials

See Our Secrets to Help you with Me, Job Space!

  1. Proven Expertise: Our coding and auditing solutions have consistently delivered improved coding accuracy and revenue optimization for healthcare providers.
  2. Client-Centered Results: We pride ourselves on helping healthcare organizations achieve better compliance and financial outcomes with our tailored solutions.
  3. Trusted Partner: Healthcare organizations rely on our comprehensive coding and auditing services to enhance documentation quality and mitigate financial risk.
  4. Measurable Impact: Our innovative approach to outpatient HCC coding and inpatient DRG validation auditing drives accurate risk adjustment and maximizes reimbursement potential.
  5. Commitment to Excellence: We focus on aligning clinical documentation with coding standards, empowering providers to capture the full value of their care.
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With over sixty years of combined experience, HealthGrade Solutions stands as a trusted partner for healthcare organizations seeking to optimize revenue, reduce denials, and enhance coding accuracy. Our deep industry knowledge, coupled with a commitment to excellence. We specialize in CMS guidelines with Inpatient DRG validation auditing to verify correct diagnosis-related group assignments, improve documentation integrity, and mitigate financial risks.

Our industry knowledge allows us to navigate the complex landscape of Risk Adjustment and reimbursement with precision in Outpatient HCC coding, ensuring accurate risk score calculations and compliance with CMS guidelines.

By leveraging cutting-edge technology, data-driven insights, and proven methodologies, we help providers capture the full value of their care, reduce compliance vulnerabilities, and maintain revenue cycle integrity. Our hands-on approach and customized solutions are designed to address the unique challenges of each organization, delivering measurable results that translate into sustainable financial performance and regulatory confidence. With HealthGrade Solutions, you gain a dedicated partner focused on maximizing the efficiency and profitability of your healthcare operations.

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Location

  • Based in the Midwest, servicing clients coast to coast

Helpdesk

(123) 456-7890

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