A Comprehensive Guide on HCC Coding Reviews
Transform Your Reimbursement Landscape: Streamline Risk Adjustment for Large Datasets with Medicare HCC Risk Adjustment Factor Batch Scoring
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Are you choosing charts randomly, or by comparing current vs past financial year claims by total revenue for retrospective or prospective review?
Either of these two approaches could lead to high revenue charts are missed out causing major revenue loss.
Are you pushing all patients, with missed or new diagnosis codes, for physician’s review and Clinical Document Improvement (CDI)?
Physicians may be spending lot of time to cover those opportunities and eventually find out that there is no real positive revenue impact, which leads to physician losing interest and start ignoring any CDI recommendation from medical coder.
Are you resubmitting all retrospective and concurrent reviewed charts?
Not all new or modified diagnosis codes will have positive revenue impact because some or All of those diagnosis code might be interacting with the existing ones.
With our Medicare HCC Risk Adjustment Factor Batch Scoring tool, you can perform retrospective, prospective, and concurrent revenue impact analysis using your Fee for Service claims data to prioritize the charts for HCC reviews and decide on resubmission confidently.
RAF Score is known for its complexity, limiting its usage among medical coders and provider organizations. Our Medicare HCC RAF Batch Scoring tool has simplified RAF Score utilization to process large datasets. It is quick and easy to use, and its revenue benefits are huge.
What is risk adjustment, and why is it so important for providers?
Well, Risk adjustment is a method used by the Centers for Medicare & Medicaid Services (CMS) to ensure that payments to Medicare Advantage (MA) plans are appropriate based on the health status of their enrollees. The MA plans to receive a monthly payment from CMS for each beneficiary enrolled in their plan, and this payment is adjusted based on the health status of the beneficiaries. In other words, plans with sicker enrollees receive higher payments to cover their higher healthcare costs.
But risk adjustment is not just important for MA plans. Medicare eligible providers, who submit Fee for Service claims for the services, can also receive additional revenue through risk adjustment by capturing all HCC-linked diagnosis codes with proper MEAT documentation. HCC MEAT documentation is a guideline for accurately documenting a patient's medical conditions in their medical record to reflect the severity of their illness and ensure appropriate care and reimbursement.
By identifying patients with more complex medical conditions and properly documenting those, providers can receive higher payments for the services they provide to the patients.
Benefits of our Medicare HCC Risk Adjustment Factor Batch Scoring Tool:
Accurate Revenue Impact Analysis:
Our tool help analyze diagnosis codes and provide insights into the revenue impact of each code, allowing providers to prioritize their efforts effectively.
Efficient Chart Review:
By utilizing our Medicare HCC Risk Adjustment Factor Batch Scoring Tool, providers can quickly identify missed documentation opportunities and focus on areas requiring improvement, streamlining the review process.
Revenue Optimization:
Medicare HCC Risk Adjustment Factor Batch Scoring Tool help identify high-value charts, and potential revenue opportunities, and prioritize them based on revenue impact, ensuring providers can maximize their reimbursement.
Data-driven Objective Decision Making:
Our Medicare HCC Risk Adjustment Factor Batch Scoring tool provide objective data on revenue, RAF scores, and comparison analysis, empowering providers to make informed decisions about clinical documentation improvement and resubmission.
Improved Efficiency:
Our Medicare HCC Risk Adjustment Factor Batch Scoring tool employs the latest technologies and offers lightning-fast batch scoring, enabling medical coders or providers to perform quick retrospective analysis and identify missed opportunities efficiently and confidently.
Our Medicare HCC Risk Adjustment Factor Batch Scoring tool offers comprehensive analysis of demographic and diagnosis codes of large volume of patients for concurrent, post-prospective, pre-prospective, post-retrospective, and pre-retrospective HCC coding. It empowers targeted clinical documentation improvement efforts, helps prioritize charts with significant revenue impact, and accurately evaluates revenue implications of new or modified diagnosis codes. Providers can review the format of the “Revenue Impact Report” by downloading the “Sample Output” file.
Explore our HCC RAF Batch Scoring Tools to conduct Revenue Impact Analysis of large datasets!
Prioritizing charts without comprehensive revenue analysis can result in overlooking potential revenue opportunities. Maximize clinical documentation improvement with our Medicare HCC RAF Batch Scoring tool.
Optimize revenue potential by making data-driven decisions and capturing all opportunities. Prioritize charts effectively using HCC RAF Score Analysis during prospective and retrospective reviews.
Evaluate revenue implications of new or modified diagnosis codes with our HCC RAF Batch Scoring tool. Make informed choices on resubmissions for deciding whether to send patient charts for review.
Prioritize charts for retrospective review using our HCC RAF Batch Scoring tool. Maximize revenue potential and capture missed opportunities by focusing on charts with high RAF Scores and revenue impact.
Concurrent coding may lead to overlooked revenue opportunities by medical coders. Our tools assist medical coders in performing quick retrospective analysis, identifying missed opportunities.
Providers can start by downloading our Excel template to populate their data. It's important to note that PHI data is not required and should not be used and that only a maximum of 10000 records are allowed. Providers can then choose their Risk Model and the corresponding Risk Factor based on the options provided in dropdowns. Our tool ensures that the appropriate Risk Factor is listed in the dropdown based on the selected Risk Model.
Once the Excel file is populated, providers can drag and drop or upload the file with their data and click the "Submit" button. The input file will be validated immediately, then it will be processed, and an output file will be created in about 5 minutes. Providers can then download the RAF scores by clicking the "Download RAF Scores" button.
Data Security and Confidentiality
At NPI Data Services, we prioritize data security and confidentiality. That's why we don't require any PHI data to use our Medicare HCC RAF Batch Scoring tool, and we validate all uploaded Excel files to ensure they meet our data formatting requirements. We also provide clear instructions and guidelines to ensure that our tool is used appropriately and effectively.
To handle (process and return) your data files, you need to sign-up and sign in to start using our Medicare HCC RAF Batch Scoring tool. Of course, you can start with the free trial plan.
Subscription Plans:
We offer annual subscription plans that are cost-effective and easy to use on our Medicare HCC RAF Batch Scoring tool. You can choose a suitable subscription plan according to your requirements. The subscription plan of NPI Data Services for Medicare HCC RAF Batch Scoring is as follows:
Medicare HCC RAF Batch Scoring - Subscription Plan & Pricing
Try our Medicare HCC RAF Batch Scoring tool free for 30 days and maximize your revenue potential. No credit card required.
| Price Plans | Trial Free | Starter | Pro |
|---|---|---|---|
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Duration
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1-month | 12-months | 12-months |
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No. of User Account
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1 | 1 | 1 |
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No. of Designated User Account
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0 | 1 | 2 |
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No of De-identified IDs
|
100 | 36000 | 72000 |
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No of RAF Scores
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2000 | 1800000 | 3600000 |
| Revenue Impact Analysis | |||
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Post-Prospective HCC Coding
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Pre-Prospective HCC Coding
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Post-Retrospective HCC Coding
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Pre-Retrospective HCC Coding
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Post-Concurrent HCC Coding
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| CMS-HCC Risk Model | |||
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Continuing Enrollee
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New Enrollee
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C SNP
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| RxHCC Risk Model | |||
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Continuing Enrollee
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New Enrollee
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| ESRD Risk Mode | |||
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Continuing Enrollee
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New Enrollee
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| Contact us | Contact us | ||
Here's what you need to know:
Number of De-identified IDs per Month:
In the "Batch Scoring Excel Template," a unique ID is assigned to each group of diagnosis codes, and these IDs must be fully de-identified to ensure that no protected health information (PHI) is included. The number of de-identified IDs that can be processed in a month is limited, and this is referred to as the "Number of De-identified IDs per Month."
Number of RAF Scores per Month:
The number of RAF scores that can be retrieved in a month depends on various factors, such as the number of de-identified IDs processed, the number of diagnosis codes included in each search, validation flags, and disease interactions within those codes. This maximum number of scores that can be retrieved in a month is referred to as the "Number of RAF Scores per Month."
Monthly Limit:
The monthly limit is reached when either the "Number of De-identified IDs per Month" or the "Number of RAF Scores per Month" hits its limit.
Number of Designated User Accounts:
This refers to the total number of user accounts that can be created and designated for processing RAF batch scoring.
Also, if you decide to cancel your subscription at any time, please note that we have a no-refund policy. Your current subscription will expire at the end of the expiry date. Payment is required in advance.
If you subscribe partway to our Medicare HCC RAF Batch Scoring tool through a month, we will pro-rate the subscription for that month and extend it for a full 12 months from the start date. For example, if you subscribe on March 12th, your subscription will expire on April 30th of the following year. The pro rate will be based on the annual subscription rate.
Don't leave potential revenue on the table by staying away from “Risk Adjustment”. Try our “Medicare HCC RAF Batch Scoring tool” today and maximize your revenue potential. And if you're new to risk adjustment, start with a retrospective revenue impact analysis to see just how much revenue you may be missing out on.
Sign up now for the free trial of our Medicare HCC RAF Batch Scoring tool or select a suitable subscription plan for your requirements.
Suggested Pages
Understanding the CMS HCC Risk Adjustment Model and its Significance
The Role of RAF Score Calculator in Achieving Sustainable Success in Risk Adjustment
Understanding HCC Risk Adjustment Coding (RA) in Healthcare Industry