HCC Risk Adjustment Factor Scoring – Innovative Approach

Many Medicare Advantage Plans strive to achieve higher HCC Risk Adjustment Factor (RAF) Scores by evaluating the health of their chronically ill patients – often using Nurse Practitioners or locum tenens physicians sent to the patient’s home. Coding experts then must dig through the chart notes of these patients looking for “lost” coding opportunities that can be filed with CMS to ultimately count toward RAF scores.

This method, known as “retrospective” healthcare analysis has some problems inherent to the process:

1. CMS is making noise about discontinuing the allowance of treatment at patients’ homes on or about the year 2015. No time frame has been cast in stone yet, but certainly the days are numbered for evaluating patients at their homes for HCC Risk Adjustment Score increases.
2. The expense of sending practitioners to patients’ homes is high – often exceeding $500 per patient or more.
3. Digging through old chart notes is difficult and time consuming and also incurs significant expense. This process does result in higher RAF Scores, but at a significant cost and “hassle factor.”
4. The analysis of the population is targeted at the 20% of the patients who have the highest chronic illnesses and co-morbidities. This technique ignores the 80% of the population that has hidden illnesses that have not come up to the surface yet.

WellTrackONE turns this process around completely by focusing on “prospective” healthcare analysis rather than “retrospective” healthcare analysis. In other words, WellTrackONE will evaluate EVERY patient in the plan, year after year, and with its proprietary “Clinical Triggers” program detects patients with chronic illnesses and co-morbidities that are previously undiagnosed and undetected. The “Clinical Triggers” will give coders accurate guides to additional coding for these undetected conditions, thereby increasing the RAF Scores on a much broader population in an evergreen and timely fashion.

WellTrackONE also offers innovative solutions to medication management and behavioral health treatments (25% of the Medicare population suffers from depression or anxiety).

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