HCC coding and risk score management

Population health management › Analytics › HCC Scoring

Find potential coding gaps in Centers for Medicaid and Medicare Services (CMS) hierarchical condition categories (HCCs) to ensure the right categories are applied to the right beneficiaries and thereby positively impact your risk adjustment factor (RAF) scores and payment adjustments.

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Overview
Overview

Key benefits

Risk-adjusted scores generated from the CMS HCC risk adjustment algorithm help predict whether a given beneficiary, or group of beneficiaries, is likely to be more or less costly to treat than the average population

Identifying coding gaps provides a way for organizations to optimize payment adjustment and reimbursement opportunities

With HCC coding and risk score management, we can determine CMS HCC categories and calculate risk-adjusted scores based on beneficiary demographics and diagnosis data to identify potential gaps in coding that you can address to impact beneficiary risk scores and payment adjustment.

You can view calculated scores and coding gaps on the risk assessment pages and patient summary reports, allowing users to view risk scores and score improvement opportunities at a beneficiary, provider or provider group level.

Features

HCC content consultation and workflow mapping

Our consultants work with your organization to analyze your provider and operational workflows, and optimize code reporting processes. Get customized alerts and reporting to better evaluate and close coding gaps.

See risk-adjusted scores

View scores at the beneficiary, provider and provider group level to identify risk score improvement opportunities. Dashboards show how scores are calculated so you can identify and act on score discrepancies over time.

Identify potential coding gaps

Year-over-year data enables you to compare changes and take action to improve your scores throughout the reporting year, as well as help predict future costs based on patient demographic and diagnosis data.

Get up and running quickly

Our services team is focused on helping your organization implement and integrate our platform and applications quickly, easily, and working harmoniously with your existing technology infrastructure. We provide initial and ongoing training to support change management, as well as support you over time to help ensure the system is meeting your current and future business goals.
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Your financial future is in your control

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Seeking customer proof points?

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