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A Playbook for Pop Health Teams: Overcoming Common HCC Coding Challenges & Improving RAF Score Accuracy

In our extensive experience working with ACOs,Playbook_Thumbnial_ we’ve seen them grapple with several challenges when it comes to HCC coding. In this playbook, we share some case studies that demonstrate how top-performing medical groups overcame these challenges to improve their HCC coding accuracy and processes.

  • Challenge 1: Limited coder staffing
  • Challenge 2: Understanding payer feedback and turning it into action
  • Challenge 3: Making the case to leadership to expand HCC coding efforts

Overcoming Common HCC Challenges - playbook

“Now out of 3,000 tasks a day, we probably have to manually review about 100. Everything else automatically posts. Clean claims go out the first time without the need to review.”
Christi Garriott
Senior Vice President of Business Intelligence and Revenue
"The automation RCxRules brought to our HCC coding process led to a dramatic productivity hike in our organization and is a key factor in our success with MSSP. The technology is extremely user friendly and the RCxRules team is flexible and responsive."
Kimberly Clifton
Director of ACO Operations, Arizona Community Physicians

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More Complete and Accurate Medicare RAF Scores

Our AI technology reviews every encounter that leaves your EMR in real time. If an encounter does not need coder review, it automatically passes through to your revenue cycle system in milliseconds. If the technology detects an HCC coding gap, it directs the encounter to a coder for review. These changes are integrated back into your revenue cycle system, so accurate claims are sent every time.

20% 20% of Medicare Advantage claims are miscoded
$250,000 A single coder working with the HCC Coding Engine can find at least $250,000 in RAF value every month
Day 1 Results starting day 1: coders can positively impact accurate RAF scores immediately after implementing the HCC Coding Engine