Featured Case Study
customer success
ACP expands HCC from 12 sites to 53 with two coders.
Arizona Community Physicians, a leader in value-based care with 53 locations and 166 multi-specialty providers, extends its HCC process across all sites, without additional headcount.
RESULTS
Proof in practice.
- 12 → 53 locations covered
- 100% of finalized encounters reviewed
- 166 providers supported
“The automation Aptarro brought to our HCC coding process led to a dramatic productivity hike in our organization and is a key factor in our success with MSSP.”
Scaling value-based care.
Arizona Community Physicians (ACP) is a leader in value-based care. Their Accountable Care Organization (ACO), Abacus Health, was selected to participate in the Medicare Shared Savings Program (MSSP) beginning on January 1, 2016.
During their first two years in the MSSP, ACP deployed a six-step manual process for 12 of their 53 locations to ensure appropriate and accurate HCC codes. Managed by three full-time ACO employees, they reviewed all medical records as well as associated claims.
This process proved to be inefficient, error-prone, and stressful for coders. Coders were constantly rushing to review claims and medical records for HCC accuracy before sending claims to payers. Often incorrect claims were discovered that had already been sent to payers, and coders then had to spend time working with the billing team to rework them.
When ACP wanted to cover all 53 locations while maintaining a thorough HCC process, they found it would have been even more inefficient and costly.
Cutting time and resources.
ACP used HCC Coding to automatically review every encounter finalized in the EMR, find any with HCC coding gaps and task them to coders. They began concurrent, real-time review of encounters instead of costly retrospective reviews. With reporting, they have provider recapture reports, and can see added and deleted HCCs and their effect on RAF value.
By automating their pre-claim coding review process, ACP brought HCC review to all locations, while keeping the same two-person coding team.
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