Access real-time CMS RAF Score with precision: Explore HCC RAF Score Analysis for actionable insights and analytics.

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As a Medicare-eligible provider, you understand the significance of claiming reimbursements for your Medicare patients via Fee for Service (FFS) claims. However, you may not realize that you could be leaving additional revenue on the table by overlooking risk adjustment opportunities within the same Fee for Service data.

Across the nation, numerous healthcare systems are failing to capitalize on substantial revenue streams due to neglecting risk adjustment. But fear not. Our HCC RAF Score Analysis tool, tailor-made for medical coders and provider organizations, is poised to assist you in embarking on a path towards increased revenue. Through comprehensive revenue impact analysis for concurrent, retrospective, and prospective reviews, we ensure that you maximize your earning potential.

RAF Score (Risk Adjustment Factor) is known for its complexity, limiting its usage among medical coders and provider organizations. However, our tool has simplified RAF Score healthcare utilization. It is quick and easy to use, and its revenue benefits are huge. On average, HCC/Risk adjustment coding can contribute approximately one-third of your FFS revenue, significantly boosting your bottom line. Below are the various types of Risk Adjustment or HCC Coding performed within the provider space.

Concurrent Coding and Our RAF Score Analysis Tools

Concurrent coding happens parallel to fee-for-service E&M coding, capturing pertinent HCC medical diagnoses as they occur during a patient's stay while adhering to MEAT criteria. Its real-time identification of HCC-contributing conditions ensures more precise risk adjustment for current reimbursement, offering additional revenue alongside Fee for Services, particularly for chronic condition management.

    Concurrent Coding Objective:

    Identifying ICD-10/Dx codes eligible for HCC linkage and submitting them for billing.

    Our Concurrent Tools Focus:

    Our HCC risk score tool Supports Clinical Documentation Improvement (CDI) by finding the high revenue impact HCC/ICDs where documentation need to be improvement. Using Risk Adjustment Factor, it generates provider education reports based on ICDs from a month of a doctor's patient volume post-concurrent coding.

Prospective Coding and Our RAF Score Analysis Tools

Prospective coding involves the anticipation or prediction of potential medical conditions and their documentation before their occurrence, relying on clinical judgment or risk adjustment factor. It involves extracting all active (from historical data) and potential conditions (from lab and radiology findings) from charts spanning the past 2-3 fiscal years. These codes are then presented to the provider during patient care, enhancing care quality and augmenting physician revenue.

    Prospective Coding Focus:

    Identifying eligible ICD-10/Dx codes linked to HCCs for CDI.

    Our Prospective Tools Focus:

    Our HCC risk score tool assists in Prospective coding by selecting and supplying only high-value charts. Facilitates Clinical Documentation Improvement (CDI) by identifying high-revenue impact HCC/ICD areas where documentation requires improvement.

Retrospective Coding and Our RAF Score Analysis Tools

Retrospective coding involves reviewing the aggregated medical records of patients for the current fiscal year after concurrent billing has occurred. The retrospective coder captures all HCC medical diagnoses initially overlooked during concurrent coding but adequately documented. This process aids in identifying missed or undocumented conditions from previous encounters, ensuring a more comprehensive and accurate representation of the patient's health status for risk adjustment purposes.

    Retrospective Coding Focus:

    Following concurrent coding and billing, conduct a cumulative re-audit and submit for billing.

    Our Retrospective Tools Focus:

    Our HCC risk score tool is utilized to compare the cumulative ICD-10 codes from concurrent coding/billing of the current year with past fiscal year ICD-10 codes to identify missed ICDs by coders and assess revenue impact, aiding in the selection of charts for retrospective review.

If you're a provider not currently involved in risk adjustment, here's how you can start leveraging our RAF Score Medicare tools to unlock new revenue streams:

    Sample Data Assessment:

    We'll compile cumulative ICDs for Fee-For-Service (FFS) patients spanning 2-3 years from a sample set. This includes E/M codes for inpatient (IP), outpatient (OP), surgery, etc., excluding lab and radiology codes.

    Prospective Coding Recommendations:

    Provide us with a sample of 100 Medicare patients' Fee For Services ICDs spanning 2-3 years, along with age and gender. Our HCC risk score tool will identify the top 20% of patients for prospective coding, enabling you to focus on high-revenue-generating charts.

    Revenue Impact Analysis:

    Using your data, we'll determine the potential revenue you could generate through Hierarchical Condition Category (HCC) or Risk Adjustment (RA) coding.

    Identification of Revenue Opportunities:

    Our Risk Adjustment Factor analysis will highlight the top revenue-generating opportunities (patients and HCCs/ICDs) with RAF Score list within your patient population.

    Financial Benefits Assessment:

    Through a pilot study, Our HCC risk score tool will evaluate the potential financial benefits of integrating HCC coding into your hospital's operations with RAF Score Analysis tools-set.

ROI Enhancement:

By targeting patients identified through our analysis, you can achieve a substantial return on investment (ROI) and improve revenue. We'll assist you in identifying these targeted patients for maximum impact.

With our services, providers not currently engaged in risk adjustment can access valuable revenue opportunities and enhance their financial performance.

If you're a provider currently engaged in risk adjustment, here's how you can harness our RAF Score Medicare tools to tap into new revenue streams:

Prospective Coding: While it is an expensive type of coding with lack of Return On Investment, we can streamline the process for you.
    • Provide historical ICD data for the 2-3 fiscal years. Our tool will analyze it, identifying patients and ICDs/HCCs with higher RAF scores. We'll accurately calculate the potential revenue and guide you in selecting charts and focusing on specific ICDs for prospective review.

    • After the prospective review, our tools will again analyze the data, pinpointing which ICD/HCCs should be prioritized for Clinical Documentation Improvement (CDI), saving significant amount of physician time in CDI.

Concurrent Coding: Though we advocate for prospective coding, we understand hospitals' hesitance due to coding cost concerns and uncertain ROI.

Documentation inconsistencies identified during concurrent coding are sometimes addressed in the same visit but those inconsistencies are addressed through retrospective review. Periodically, all feedback, including flags denoting ICD10 additions, deletions, modifications, or no changes, undergoes retrospective evaluation. These flags provide valuable insights for generating analytics on individual doctors’ documentations, diagnoses, and patients, identifying top performers and areas requiring improvement. When documentation is incomplete or omitted by doctors or coders, assessing revenue loss becomes difficult. Our tools pinpoint revenue impacts, improving documentation accuracy, aiding in provider education, and directing providers' focus to specific codes and charts for enhancement.

Maximize your Revenue with our advanced HCC RAF Score Analysis Tools

Boost physician confidence: Share RAF score & revenue impact in CDI recommendations & provider report.

Post-Prospective HCC Coding Review Analysis

By sharing our RAF score and accurate revenue impact details as part of your CDI recommendations and provider education report, you can significantly improve the confidence of physicians.

RAF Score Analysis: Optimize revenue by identifying high-value charts for prospective reviews.

Pre-Prospective HCC RAF Analysis

By leveraging the RAF Score Analysis tool, you can confidently identify charts that have the greatest impact on revenue, allowing for strategic decision-making during prospective reviews.

Risk Adjustment Factor Score tool analyzes ICDs for revenue opportunities, guiding resubmission decisions.

Post-Retrospective HCC Coding Review Analysis

Our RAF Score tools analyze new or modified ICDs and provide RAF score and revenue opportunities, and it enables us to decide whether a chart should be sent for resubmission or not.

RAF Score tools: Prioritize high-value charts, minimizing risk of missed revenue

Pre-Retrospective HCC RAF Analysis

Our RAF Scoring tools enable you to prioritize the charts with the highest RAF Scores and revenue impact and it can mitigate the risk of missing out high-value charts.

Maximize revenue impact with precise RAF Score recommendations in provider education reports

Post-Concurrent HCC RAF Analysis

With RAF Score Analysis, you can elevate the confidence in your provider education report by giving accurate recommendations for high-priority and low-priority diagnoses based on RAF scores and revenue impact.

Important note:No need to sign-up or sign in to start trying RAF score analysis tool. Click the above “Try it!” to start experiencing our tool. If you're not logged in, you'll only be able to use our tool a specified number of times per day. To use the tool more frequently, you'll need to sign up for an account.

Subscription Plans:

You can choose a suitable subscription plan according to your requirements. The subscription plan of NPI Data Services for HCC RAF Score Analysis is as follows:

HCC RAF Score Analysis - Subscription Plan & Pricing

Try our "RAF Score based revenue impact analysis" tool free for 30 days. No credit card is required.

Price Plans Trial Free Starter Pro
No. of User Account
No. of RAF Scores/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
Contact usContact us

We offer an annual subscription that is both cost-effective and easy to use. With this subscription, you will receive a set number of daily hits each day for an entire year. Any unused daily hits will expire at the end of each day, so you can be sure you're getting the most out of your subscription.

Heres what you need to know:

Searches per day:

Each time a user submits a search on the HCC RAF Score Analysis portal, it counts as one search. The maximum number of searches allowed per day is limited.

RAF Scores per day:

The number of RAF scores that can be retrieved per day depends on factors such as the number of diagnosis codes included in each search, validation flags, and interactions among the diagnosed conditions. The maximum number of RAF scores that can be retrieved per day is also limited.

Once the daily limit for either searches per day or RAF Scores per day is reached, no further RAF Score searches can be conducted. 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 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. If you want to renew your existing subscription, you can renew it by logging in to your account or by contacting us.

Every healthcare provider should encourage their medical coders to use our HCC RAF Score Analysis tool as part of the coding workflow to have significant revenue impact. Don't stay away from “Risk Adjustment” and leave money on the table when it comes to Medicare reimbursements. Try our "Risk Adjustment revenue impact analysis" tool using your Fee for Service claims data and discover your potential risk adjustment revenue.

Sign up now for the free trial or select a suitable Risk Adjustment Factor Score Analysis subscription plan for your requirements.

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