CMS HCC RAF Score Analysis Tool for Post-Concurrent Review Click to edit
CMS HCC RAF Score Analysis Tool for Post-Concurrent Review
To be used for DOS from Jan 1, 2024, to Dec 31, 2024
Sample Data: C9200,D66,G8250,G7001,E1152,E849,E1122,N185,E7402,I5023 Use this!
S.No ICD 10 CM Code Validation Flag HCC Value Diagnosis Description Delete Record
1
S.No ICD 10 CM Code Flag CMS-HCC-V24 CMS-HCC-V28 Diagnosis Description Delete Record
1
Category Pre Audit Post Audit
RAF Score MA Payment RAF Score MA Payment
Category CMS-HCC-V24 CMS-HCC-V28
ICD10 HCC Post Audit Pre Audit HCC Post Audit Pre Audit Post Audit Pre Audit
RAF Score MA Payment RAF Score MA Payment RAF Score MA Payment RAF Score MA Payment RAF Score MA Payment RAF Score MA Payment

Maximize Revenue Potential and Physician Satisfaction with Our RAF Score Analysis Tool for Concurrent Risk Adjustment!

Our RAF Score Analysis Tool for Concurrent Review is a game-changer for medical coding companies and healthcare providers seeking to enhance physician satisfaction, streamline coding processes, and maximize revenue potential with concurrent risk adjustment coding. By incorporating the RAF score analysis tool and revenue impact assessment, this tool ensures that no valuable insights go unnoticed while doing concurrent reviews.

The revenue impact analysis report can be downloaded and will supplement the Provider Education Reports, generated every month, quarter, or year, from concurrent review data and the downloaded revenue impact analysis report is a key feature of our tool. Traditionally, medical coders share reports that include information on changes made to diagnosis codes, such as additions, deletions, modifications, and codes that remain unchanged. However, physicians often ignore these findings, as most ICDs have the same HCC value. Physicians’ confidence in the provider education report can be drastically improved by incorporating our RAF Score Analysis Tool in the HCC coding review.

Our RAF Score Tool for concurrent risk adjustment coding takes the guesswork out of the equation by analyzing these ICDs and accurately recommending high and low-priority diagnoses based on RAF scores and revenue impact. By incorporating the RAF score and revenue impact in the provider education report, medical coders can ensure that physicians pay close attention and take appropriate action on it after concurrent reviews.

Not only does our RAF Score Analysis Tool for concurrent risk adjustment coding improve physician satisfaction, but it also presents an opportunity for medical coding companies to generate additional revenue. By providing a revenue impact analysis report as part of a concurrent risk adjustment coding review, medical coding companies can showcase the financial benefits by optimizing clinical documentation.

The tool takes RAF model, RAF factors, demographic data and set of diagnosis codes (ICD10) and each with one of the following validations flags.

No Changes (NC):

ICDs that remain unchanged during the chart review.

Deletion (DL):

ICDs that are deleted due to lack of documentation.

Modification (MD):

ICDs that are modified from one code to another during the chart review due to specificity & cause and effect relationship.

Addition (AD):

ICDs that are added during the chart review.
Demographic Inputs
Risk Model
Risk Factor
Gender
Age