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

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.

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:

• 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.