RISK ADJUSTMENT CODING SERVICE BUSINESS PLAN

I. Executive Summary

Company Description

PrecisionRisk Health Consulting — named for our focus on precise clinical risk capture — is a U.S.-based healthcare consulting firm launching in 2026 that sits at the intersection of clinical coding and revenue integrity. We operate in the value-based care and risk-adjustment sector, providing expert-led audits, coder training, and chart review services that ensure accurate diagnosis coding. Our core offerings combine certified specialist reviews with proprietary analytics delivered over a secure, HIPAA-compliant remote platform. One-liner: we translate clinical detail into accurate risk scores that protect client revenue.

We serve payer groups, accountable care organizations, Medicare Advantage plans, and health systems that need to optimize reimbursement and compliance. Day-to-day we run structured audits, train clinical coders, integrate analytics into client workflows, and deliver remediation plans. What sets us apart is the blend of human-certified expertise plus a validated analytics engine and strict HIPAA security. Short-term goal: onboard 10 paying clients and validate outcomes in 2026. Long-term goal: become the standard revenue-integrity partner for mid-size and large healthcare organizations nationwide. One-liner: we reduce missed revenue and audit risk through proven coding accuracy.

Problem

Healthcare providers in the U.S. lose material revenue because incomplete or inaccurate diagnosis coding understates patient risk scores, lowering Risk Adjustment Factor (RAF) payments in value-based care programs such as Medicare Advantage. This creates concrete outcomes: lost revenue, higher audit frequency, and increased compliance risk when documentation fails to reflect true clinical complexity.

Existing market options do not consistently combine certified clinical coding expertise, compliant documentation practices, and analytics at scale. The CMS-HCC transition from Version 24 to Version 28 increases mapping and submission complexity, so providers need specialized, HIPAA-compliant services that both recover missed payments and reduce audit exposure. Incomplete coding today is a measurable revenue gap that current solutions leave largely unclosed.

Solution

Healthcare providers lose revenue and face audit risk when diagnosis coding understates patient risk—especially in Medicare Advantage and value-based care. Our service reviews patient encounters and medical records, integrates a proprietary data analytics platform with client EHRs, and delivers targeted training and defensible coding workflows to close coding gaps and protect reimbursement.

We flag high-risk patients for focused review, train physicians and clinical documentation specialists, and implement audit-proof coding programs so providers recover lost revenue and reduce compliance exposure.

Mission Statement

We empower healthcare organizations to achieve total coding integrity by combining expert clinical coding, advanced technology, and sustainable education so every patient's health status is accurately reflected. We secure appropriate reimbursement and maximize revenue integrity while upholding the highest standards of regulatory compliance. Accurate data drives better care management, supports the transition to value-based care, and strengthens financial stability across the U.S. healthcare system.

Key Success Factors

These factors drive scalable revenue, margin improvement, and steady client acquisition.

• Dually-certified coding team delivers nuance software alone cannot match.
• Proprietary analytics platform enables scale and deep client insights.
• Financial milestones: breakeven in 6 months and 17-month payback.
• Decreasing CAC and shift to high-margin monthly retainers improve unit economics.
• Strategic partnerships with EHR vendors and associations supply high-value leads.

Financial Summary

This Financial Summary presents the near-term revenue, profitability, and investor returns for the Risk Adjustment Coding Service.

Financial requirements include a minimum operating cash buffer of $656,000 (maintained from Jun-26) to reach breakeven (Jun-26) and achieve payback in 17 months; anticipated investor returns are IRR 10.82% and ROE 11.7%.

The business is scalable, with revenues growing to $8,832,000 by 2030 and EBITDA to $5,182,000, supporting the outlined returns.

Funding Requirements

We require USD 656,000 to fund launch and maintain a minimum cash position through breakeven (June 2026); projected revenue is $1,103,000 in Year 1 rising to $8,832,000 in Year 5, EBITDA grows from $137,000 in 2026 to $5,182,000 in 2030, IRR 10.82%, ROE 11.7%, and COGS falls as a percent of revenue supporting scalability.