CMS HCC RAF Score Analysis Tool for Post-Retrospective Coding Click to edit
CMS HCC RAF Score Analysis Tool for Post-Retrospective Coding
S.No ICD 10 CM Code Validation Flag HCC Value Diagnosis Description Delete Record
Category Pre Audit Post Audit
RAF Score MA Payment RAF Score MA Payment

Improve Efficiency and Optimize Revenue with our RAF Score Analysis Tool for Retrospective Risk Adjustment Coding.

Our CMS HCC RAF Score Analysis Tool for retrospective risk adjustment coding is a powerful solution designed specifically for Retrospective Coding. This innovative tool empowers providers and medical coders to conduct efficient, in-depth, and accurate reviews of diagnosis codes from retrospective reviews.

By analyzing the diagnosis (ICD10) codes and their potential revenue impact, the RAF Score Analysis Tool for retrospective reviews ensures that no eligible diseases are missed out, allowing healthcare providers to optimize revenue streams and improve overall financial performance.

Following are some of the benefits of the tool for retrospective risk adjustment coding:

Accurate and Efficient Chart Reviews:

The RAF Score Analysis Tool streamlines the post-validated chart review process, eliminating the need for time-consuming manual evaluations. It automatically analyzes the ICD10 codes and presents a comprehensive view of potential changes before and after the HCC review, saving valuable time and effort for medical coders and providers during retrospective risk adjustment coding.

Revenue Impact Assessment:

Not all new or modified ICD10 codes have the same revenue implications. Some new diagnoses may interact with existing or modified ones, and determining the exact revenue impact can be a daunting task. Because of the additional disease interaction due to cause-and-effect relationship between two diagnosis codes, it will increase the revenue and RAF. For example, diabetes is e11.9 with $983 & CKD unspecified is n18.9 with $0, but after combining diabetes with CKD, it is e11.22 with $2828 revenue.

The RAF Score Analysis Tool for retrospective risk adjustment coding is designed for medical coders to use after the HCC review, and it identifies which diagnosis codes will have significant revenue impact, and which ones will have low revenue impact. This insight helps healthcare providers prioritize their efforts and focus on the most financially significant charts for re-submission.

Integration with Existing Medical Coding Workflow:

The RAF Score Analysis Tool for retrospective risk adjustment coding seamlessly integrates with existing medical coding workflow, making it easier to incorporate into established workflows. There is no need for a complete overhaul of the current processes, but it ensures a smooth and quick adoption.

Operational Cost Savings:

By proactively finding charts with low revenue impact and avoiding re-submitting those charts results in significant savings in direct and indirect costs of resources in re-submission, follow-ups, reconciliation, and other related activities.

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