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Adding one coder and HCC Engine increases RAF score 34% 

 

Picture this…you’re a well-established healthcare provider that has been serving the community since 1916. With a patient-centered approach to care, you’ve made a commitment to aggressively move into value-based care to improve patient care while reducing costs. However, to take on more risk-based contracts, a scalable and cost-effective approach to ensure profitability was a necessity.

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The results

TOUCH
Increased average RAF score 34%
Increased average RAF score 34%

Increased average RAF score 34%

TOUCH
Captured additional $504,220 in revenue
Captured additional $504,220 in revenue

Captured additional $504,220 in revenue

TOUCH
Increased potential to earn
Increased potential to earn

Increased potential to earn

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

While investing in clinical initiatives improved patient care, staff realized RAF scores did not accurately match patient population. Patients were sicker than RAF scores indicated.

The solution

By hiring a single HCC coder to concurrently review value-based encounters, the practice leveraged the Aptarro software to improve RAF scores through increased HCC capture/re-capture rates.

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Proof

Real, satisfied customers

“The value of Aptarro software is unprecedented, in fact, it’s a necessity for any organization with risk-based contracts.”

CEO

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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