+ 1 646 540 9697 
Clearing a 300,000-Chart HCC Coding Backlog for a Medicare Advantage Plan in Illinois with Revix Health
Overview
A leading MA health plan based in Illinois was facing a significant risk to its risk adjustment revenue due to an overwhelming backlog of over 300,000 charts requiring Hierarchical Condition Category (HCC) coding. With submission deadlines approaching and internal resources stretched thin, the health plan partnered with Revix Health for a rapid and high-quality resolution.
“Revix Health proved to be an invaluable partner during one of the most critical times for our organization. They rapidly deployed a highly skilled team of certified coders and ensured we had full visibility into progress and quality. Their ability to clear the entire backlog was truly impressive”
SVP, clinical operations
Challenges
The health plan had a massive backlog of 300,000+ charts accumulated over several months due to staffing shortages and a surge in member encounters.
Internal teams lacked the scalable infrastructure and certified resources needed to process this volume within CMS submission timelines.
There was concern over coding accuracy, HCC capture gaps, and potential revenue loss from underreported risk scores.
Solution Implemented
Rapid Resource Deployment: Revix Health quickly mobilized a dedicated team of 75+ certified HCC coders, all trained in risk adjustment and CMS guidelines.
Phased Approach: The backlog was divided into phases based on encounter date and priority, ensuring that high-impact charts were coded first.
Technology-Enabled Workflow: Revix leveraged a secure, HIPAA-compliant coding platform with integrated QA workflows and productivity dashboards to ensure real-time monitoring and auditing.
Quality Oversight: A dedicated clinical QA team performed dual reviews and audits, consistently maintaining accuracy rates above 97%.
Daily Reporting & Transparency: Regular progress reports, coding summaries, and risk gap trends were shared with the plan’s internal teams and leadership to ensure alignment.
Outcomes
Backlog Cleared: The entire backlog of 300,000 charts was completed within 90 days, well ahead of CMS deadlines.
Coding Accuracy: Maintained a consistent 97%+ coding accuracy rate, validated through internal audits and third-party reviews.
Improved Risk Score Capture: Identified significant HCC coding opportunities, directly contributing to improved RAF scores and revenue uplift.
Client Confidence Restored: The health plan resumed its normal cadence of coding and submissions, with Revix retained as a long-term HCC coding partner.
Explore More