Center for Primary Care (CPC) is headquartered in Georgia and has over 40 providers in eight locations across two states. They have been providing primary care services since 1993.
Several years ago, the team at Center for Primary Care joined the Medicare Shared Savings Program (MSSP). They also participate with several Medicare Advantage (MA) plans. To align with their ACO and MA plans, CPC needed to ensure their HCC coding and RAF scores were accurate.
Like many medical groups, they faced a common HCC coding challenge: their physicians didn’t really understand the nuances of risk coding, and the burden of improving RAF score accuracy fell largely on their team of billers and coders. It was important for them to get their physicians familiar with the implications of HCC coding so that documentation could improve and their team of coders could capture the most specific HCC codes.
They also had the added challenge of an extremely manual HCC coding workflow. Their coders worked off a paper list of HCC codes and had to manually check encounters against this list to ensure accurate HCC coding. They lacked the reporting capabilities and staff needed to identify areas for improvement.
The Solution: The HCC Coding Engine
They turned to the HCC Coding Engine to streamline their risk adjustment coding workflow and improve their RAF score accuracy through automation. The software immediately helped their billing and coding team to work more efficiently. “Our team didn’t take long at all to get comfortable using the HCC Coding Engine. We were able to hit the ground running as soon as the product was in place and start impacting our RAF scores,” explains Lauren Sightler, Director of Population Health at CPC. The in-depth reporting features allowed them to quickly identify priority areas for physician education.
Rather than having coders check each encounter against a paper list of codes, the HCC Coding Engine identifies critical, high-value HCC encounters that lack specificity, have not been properly captured, or have codes that need to be deleted, so coders can make the most of their time and skills. “The HCC Coding Engine cuts down on tedious work since the coders no longer have to manually look for codes, and it ensures that we’re coding to specificity,” says Shymeka Lewis, Coding Manager at CPC. By automatically processing encounters that have been correctly coded, the AI also cuts down on the number of encounters each coder has to check, which helped the group get the most out of their existing coding team without having to hire additional staff.
Additionally, the HCC Coding Engine’s reporting capabilities helped the CPC team identify common issues their coders were addressing over and over. For example, they were able to see that providers frequently included too many diagnosis codes on a single encounter. The team took this information to their providers to remedy the problem through education, reducing the burden on the coding team.
Reduced Burden on Providers
In addition to streamlining their coders’ workflow, the HCC Coding Engine also helped ease the workload of their busy physicians. “The physicians are very receptive to the education we’ve been providing. A lot of the time the coders can resolve issues with no need for physician input, so we’re reducing the burden on our providers as well as on our coders,” Sightler explains.
Find out how other large medical groups use RCxRules software to boost staff efficiency and improve RAF score accuracy by exploring these success stories.