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Center for Primary Care uncovered $6M RAF value in first year with HCC Coding 

 

Picture this…you’re a leading primary care provider who joined the Medicare Shared Savings Program (MSSP) and participates with several Medicare Advantage plans. You need to align your ACO and MA plans to ensure HCC coding and RAF scores are accurate. But physicians don’t understand the nuances of HCC coding your RCM team is feeling the pressure of managing a manual process without accurate reports and adequate staff.

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The results

TOUCH
Uncovered $6M RAF value the first year
Uncovered $6M RAF value the first year

Uncovered $6M RAF value the first year

TOUCH
Improved efficiency without adding more staff
Improved efficiency without adding more staff

Improved efficiency without adding more staff

TOUCH
Reduced coding burden
Reduced coding burden

Reduced coding burden

The results

radar
 

Reduced/Reallocated

 

10+ FTEs
 
accuracy
 

Reduced Time

 

from date of service to claim submission by two days
optimization
 

Decreased

 

clearinghouse and payer rejections by 3%
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Improved

 

claim resolution rate by 25%
 
 
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The challenge

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. The entire team is managing with an extremely manual HCC coding workflow.

The solution

CPC turned to the Aptarro HCC Coding Engine to streamline their risk adjustment coding workflow and improve their RAF score accuracy through automation.

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Proof

Real, satisfied customers

“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.”

Director of Population Health at CPC

The benefits

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The group was able to reduce two full-time positions and reallocate another two full-time positions on their Charge Entry Team. They reduced 11 hours per day of manual charge entry; and automated charge cloning, missing charge reconciliation, and practice transfer. On their AR Team, they were able to reduce four and a half full-time positions and reduce denial tasks by 22%. Finally, on their Coding Team, they were able to reduce two fulltime positions and reduce coding denial tasks by 75%. In all, they were able to reduce or reallocate over ten full-time positions.

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In addition to remedying their staffing challenges, these changes positively increased staff morale and allowed for more professional growth among their existing staff. The simplified processes also eased staffing changeovers and reduced the administrative burden on IT.

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The time from date of service to claim submission was reduced by two days. Their clearinghouse and payer rejections decreased by 3%, backend rejections went from 40% of total rejections down to 15%, and their claim resolution rate three months after implementation was up by 25% of the available opportunity.

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