Stay Ahead in Risk Adjustment: Discover the Medicare HCC RAF Score Web Service for Real-time Calculation of Risk Adjustment Factor (RAF) Score

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Are there any missed opportunities in documenting and reporting risk-adjusted diagnoses, despite actively treating the patients and if so, do these missed opportunities have any revenue potential, and if they do, how much could that be?

Are there diagnosis codes for conditions that are treated but not documented with severity, laterality, specificity, cause and effect relationships, and status of the conditions and if so, do they have any revenue potential, and if they do, how much?

Do you pass all missed diagnosis codes to physicians for Clinical Document Improvement (CDI) with the hope that it may bring in high revenue or do you perform revenue impact analysis to accurately determine the revenue gain before putting expensive CDI efforts?

Are you simply passing all new diagnosis codes to physicians for clinical document improvement, with the hope that it may bring in high revenue?

With our Medicare HCC RAF Score Web Service, you can easily perform revenue impact analysis with RAF scores on prospective reviewed charts. It is a powerful and efficient tool designed for the real-time Risk Adjustment Factor (RAF) score calculation and to provide solution to address above problems.

RAF Score is known for its complexity, limiting its usage among medical coders and provider organizations. Our Medicare HCC RAF Score Web Service has simplified RAF Score utilization. It is quick and easy to integrate with any apps, and its revenue benefits are huge.

What is risk adjustment and HCC Risk model, and why is it so important?

Risk adjustment is a method employed by the Centers for Medicare & Medicaid Services (CMS) to ensure fair and adequate payments to Medicare Advantage (MA) plans and eligible providers. By accurately documenting and capturing Hierarchical Condition Category (HCC)-linked diagnosis codes, providers can demonstrate the severity of their patient's medical conditions using HCC Risk models from Centers for Medicare and Medicaid Services (CMS), thus justifying higher reimbursement for the services provided.

Introducing Medicare HCC RAF Score Web Service:

Our web service analyzes each diagnosis code and the interactions among diagnosis codes, and with disability, age, and demographic factors using CMS HCC risk models and factor, identifying revenue opportunity and prioritizing areas for clinical documentation improvement. This helps physicians focus their efforts on specific diagnosis codes with high revenue potential, boosting revenue and avoiding wasted time on diagnosis codes with little or no impact in revenue. This innovative web service is accessible via the API provided by NPI Data Services, making it easily integrable into any third-party system or Health IT product.

Web Service Free Trial!
How to use the web service?

Benefits of Medicare HCC RAF Score Web Service:

  1. Perform revenue impact analysis with RAF scores on prospective reviewed charts. Determine if patient charts should be sent to improve clinical documents and generate Provider Education Reports with RAF scores and revenue opportunities.
  2. Perform revenue impact analysis with RAF scores on retrospective and concurrent reviewed charts. Decide whether patient charts should be resubmitted or dropped from re-submission.
  3. Perform revenue impact analysis with RAF scores before retrospective and prospective reviews. Use the data to make informed decisions on which charts should undergo HCC review.
  4. Perform accurate risk stratification of patient population into low, medium, and high-risk patients.
  5. Perform Medicare HCC risk score simulation, and make decisions on revenue enhancement or cost reduction confidently, before or after any type HCC chart reviews.

Experience real-time RAF score calculations with ease using our HCC RAF Score REST API

Post-Prospective HCC Coding Review Analysis

Leverage our Medicare HCC RAF Score web service to prioritize ICDs based on low or high revenue impact. Generate Provider Education Reports that highlight RAF scores and Revenue Opportunities, empowering targeted clinical documentation improvement.

Pre-Prospective HCC Coding Review Analysis

Confidently prioritize charts with the greatest revenue impact using our RAF Score web service during prospective and retrospective reviews. Make data-driven decisions to maximize revenue potential and capture all opportunities.

Post-Retrospective HCC Coding Review Analysis

Evaluate revenue implications of new or modified diagnosis codes accurately using our RAF Score web service. Determine whether a chart should be resubmitted or ignored based on precise revenue impact calculations.

Pre-Retrospective HCC Coding Review Analysis

Prioritize charts for retrospective review using our Medicare HCC RAF score web service. Focus on charts with high RAF Scores and revenue impact to maximize revenue potential and capture missed reimbursement opportunities.

Post-Concurrent HCC Coding Review Analysis

Elevate the value of your provider education report by incorporating our RAF Score web service. Provide accurate recommendations based on RAF scores and revenue impact, guiding providers towards critical areas for clinical documentation improvement.

Getting started with the Medicare HCC RAF Score REST API is incredibly easy using the following steps:

  • Simply sign up below for a free trial of our HCC RAF score web service on the NPI Data Services website and receive your unique API key via email within seconds.
  • Once you have your API key, you can easily integrate the web service into your existing systems or products. The user-friendly interface allows for seamless navigation to try the API before the integration, and utilization of the API.
  • To try out the RAF Score REST API, navigate to the RAF Score REST API user interface, all you need to do is click on the "Authorize" button. Enter your API key and proceed to the POST command section.
  • By clicking the "Try it out" button, you can edit the parameters in the request body according to your requirements.
  • Select the parameters to be passed to REST API with API Key: Risk Adjustment Model, Risk Adjustment Factor, Patient age, Patient gender and diagnosis codes with corresponding validation flags.
  • Once the parameters are set, simply press the "Execute" button to obtain the RAF Score revenue impact analysis in the response body. For convenience, a sample dataset is available for ‘download’, which can be used as request parameters to immediately try out the REST APIs.

Why Medicare HCC RAF Score Web Service by NPI Data Services?

The Medicare HCC RAF Score Web Service offers many benefits for medical coders and organizations involved in HCC coding. By leveraging real-time calculation capabilities, coders can significantly improve efficiency and accuracy in their coding processes. The seamless integration with existing systems ensures a smooth transition and minimizes disruption to workflows.

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 web service. We also provide clear instructions and guidelines to ensure that our tool is used appropriately and effectively.

Subscription Plans:

We offer annual subscription plans that are cost-effective and easy to use. You can choose a suitable subscription plan according to your requirements. The subscription plan of NPI Data Services for Medicare HCC RAF Score Web Service is as follows:

Medicare HCC RAF Score Web Service - Subscription Plans & Pricing

Try Risk Adjustment HCC RAF Score REST API web services free for 30 days. No credit card required

Price Plans Trial Free Starter Pro
No. of User Account
Searches per day
RAF Scores per day
Revenue Impact Analysis
Post-Prospective HCC Coding
Pre-Prospective HCC Coding
Post-Retrospective HCC Coding
Pre-Retrospective HCC Coding
Post-Concurrent HCC Coding
CMS-HCC Risk Model
Continuing Enrollee
New Enrollee
RxHCC Risk Model
Continuing Enrollee
New Enrollee
ESRD Risk Mode
Continuing Enrollee
New Enrollee
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Here’s what you need to know:

Daily API Usage Limit:

Ensure you are aware of the maximum number of times you can invoke the REST API in a single day. This limit, known as "Hits/Day," defines the cap on API calls you can make within a 24-hour period.

RAF Score Retrieval Limit:

The number of RAF scores you can retrieve per day is influenced by several factors, including the quantity of de-identified IDs processed, the number of diagnosis codes included in each search, validation flags, and disease interactions within those codes. This limit is referred to as the "Number of RAF Scores per Day."

API Key Requirement:

Access to the RAF Score REST API is granted through a unique API KEY. Obtaining this key is a straightforward sign-up process and allows you to utilize the API seamlessly.

Subscription Cancellation and Refunds:

Please be aware that our subscription plans operate under a no-refund policy. Should you choose to cancel your subscription, it will remain active until the expiration date. Payment for the subscription is required in advance.

Pro-rated Subscriptions:

If you subscribe to our services partway through a month, we will calculate the subscription fee based on a pro-rated amount. The subscription will then be extended 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-rated amount will be determined based on the annual subscription rate.

Don't leave potential revenue on the table by staying away from “Risk Adjustment”. Start integrating our Risk Adjustment tools into your medical coding operations today and reap the benefits of a proactive and financially successful approach. Try our “Medicare HCC RAF Score Web Service” today and maximize your revenue potential.

Sign up now for the free trial or select a suitable subscription plan for your requirements.