The RCxRules Blog

2023 Is Coming! Plan (and Budget) for These Risk Adjustment Challenges

Medical groups today are facing unprecedented levels of provider burnout and staffing shortages. To succeed in value-based contracts, groups need to accurately align RAF scores with their patients’ health status—and they need to figure out how to do this with fewer staff resources. As the new year approaches, 2023 is sure to hold many of the same challenges. So how can groups set themselves up for success? When allocating budgets for next year, groups should consider investing in automation solutions that can help with these common challenges.

Alleviating Provider Burnout Through Automation

The pandemic has driven burnout among health care workers to record high levels. Since the start of the crisis, 60% to 75% of clinicians have reported symptoms of exhaustion, depression, sleep disorders and PTSD. About 20% of healthcare workers have quit during this period, and 4 out of 5 of those who remain say that staff shortages have affected their work. It’s more important now than ever to reduce the administrative burden on physicians.

How can medical groups meet their risk adjustment goals without further contributing to provider overwork and burnout? HCC coding doesn’t have to be a provider problem. Providers went to medical school to become doctors, not coders. They know how to provide excellent patient care, and are proficient at documentation, but often struggle to translate the care provided into HCC codes. The RCxRules HCC Coding Engine automatically finds encounters that have been well documented but inaccurately coded and directs them to coders for review. There’s no additional work required of providers.

No Coders? No Problem.

In addition to provider burnout, many medical groups are battling severe staffing shortages. When billing and coding teams are stretched thin, revenue can fall through the cracks. Even medical groups that don’t have any in-house coders or enough coders can leverage AI to improve their RAF score accuracy.

RCxRules and AAPC have partnered up to offer the Advanced HCC Coding managed service. With this unique solution, the RCxRules HCC Coding Engine automatically finds encounters that have likely been well-documented but poorly coded and directs these encounters to AAPC Certified Risk Adjustment coders for review.

The Best Part? Budgeting for this Solution is Simple.

Groups only pay when an HCC code is added, modified, or deleted — so the cost directly correlates to the value received from the solution. This combination of industry-leading technology and resources will improve your RAF score accuracy without increasing provider workload or adding additional strain to your risk adjustment team.

Set Yourself Up for Success in 2023. Learn how our AAPC Managed Service Can Help.

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