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A Risk-Free Approach to Risk Adjustment: A New Managed Service from RCxRules and AAPC

A Risk-Free Approach to Risk Adjustment: A New Managed Service from RCxRules and AAPC

RCxRules and AAPC are partnering to offer a new managed service that improves RAF score accuracy while helping medical groups overcome today’s rampant staffing challenges. 79% of health care professionals say the national worker shortage has affected them and their place of work. Population health teams, clinical staff, and providers are doing everything they can to ensure the most accurate RAF scores, but when people and processes are stressed, HCC capture is more likely to fall through the cracks.

When gaps inevitably form between documentation and HCC coding, this new managed service is here to close them. It acts as a safety net, catching errors and making sure HCC codes are captured accurately. With this risk-free managed service, medical groups only pay for codes that are added, modified, or deleted—so the cost directly correlates with the value provided.

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Today’s Risk Adjustment Challenges

There’s no denying that HCC coding is complex. There are over 70,000 ICD-10 codes, roughly 9,500 of which map to 86 HCC conditions with 19 varying categories. There are over 400 diagnosis codes associated with diabetes alone.

Physicians didn’t go to medical school to learn the intricacies of HCC coding—their focus is on providing the best possible care to their patients. This means that physicians are often much better at clinical documentation than HCC coding. We’ve found that one third of encounters flagged by our HCC Coding Engine are underreporting HCC codes when compared to the physician documentation.

Provider education can be a great tool, but we don’t believe that HCC coding should be seen as solely a provider problem. Providers are already overwhelmed and overburdened—since the start of the pandemic 60% to 75% of clinicians are reporting symptoms of exhaustion, depression, sleep disorders and PTSD. So how can medical groups improve RAF score accuracy without increasing the burden on providers?

The RCxRules + AAPC Advanced HCC Coding Managed Service

Our most successful customers have found that leveraging both certified risk adjustment coders (CRCs) and HCC coding automation is the most reliable and cost-effective way to ensure risk adjustment success. This approach also eases the administrative burden on physicians, empowering them to focus more time and attention on patient care.

Many medical groups don’t have in-house coders (or have too few coders for their current workload), which is where AAPC comes in. AAPC is widely recognized as the gold standard in medical coding. With expertise in more than 80 specialties, AAPC experts operate efficiently, code accurately, and mitigate risk for every size and type of healthcare organization.

With this new managed service, you get the best talent and technology. By combining AAPC CRCs with AI technology from RCxRules that automatically finds encounters that have been well documented but inaccurately coded, you can dramatically improve RAF score accuracy and find over $250K in RAF value per month. This managed service has a risk-free pricing model, meaning medical groups only pay for codes that are added, modified, or deleted. Schedule a 15-minute meeting to learn more.

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