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3 Reasons Why It’s Time to Switch to a Concurrent Risk Adjustment Review

3 Reasons Why It’s Time to Switch to a Concurrent Risk Adjustment Review

Medicare Advantage continues to grow, making HCC capture a priority for more medical groups than ever. Accurate RAF scores are critical to success, which is why medical groups are increasingly switching their coding focus from a retrospective review process to a concurrent one. If your medical group hasn’t made the switch yet, now is the time.

1. Increase Efficiency and Overcome Staffing Challenges

A concurrent process is simpler and more efficient, allowing coders to get more done in less time. As medical groups struggle with staffing challenges and coding teams are stretched thin, a concurrent review process can help optimize coder productivity.

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2. Avoid Costly Audits

As the Department of Justice (DOJ) cracks down on healthcare fraud, organizations that rely on retrospective HCC coding reviews may find themselves under a microscope. The DOJ is on the lookout for fraudulent diagnoses added after care has been provided and documented. By implementing a concurrent HCC coding process, medical groups can capture all relevant diagnoses at the point of care and ensure data is both documented in the medical record and submitted appropriately on the claim.

3. Reduce Re-work for Revenue Cycle team

By using a retrospective coder review to catch HCC coding errors you are adding work for your revenue cycle team. When HCC codes are inevitably missed or incorrectly added, revenue cycle team members must spend countless hours correcting and resubmitting claims. A concurrent review process allows coders to correct claims before they go out, the first time. Coding changes are made before the initial claim is submitted which eliminates the backend work necessary with a retrospective process.

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How RCxRules Can Help

The RCxRules HCC Coding Engine can help with an easy transition and successful execution of a concurrent review process. To avoid overwhelming your HCC coders with the need to review all encounters at once, the software uses filtering logic to help prioritize and target the highest value encounters.

To learn more about how the HCC Coding Engine can help you effectively move to a concurrent review process and increase RAF score accuracy, set up a meeting today.

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