Featured Case Study
customer success
Center for Primary Care surfaces $6M in RAF value.
Center for Primary Care replaces paper-based HCC review with automated prioritization across 40+ providers and eight locations, helping its existing coding team capture more accurate risk without adding staff.
RESULTS
Proof in practice.
- $6M uncovered in RAF value in the first year
- 0 additional budgeted staff needed
- 40 providers covered
“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.”
A multi-location group focused on value-based care.
The team at Center for Primary Care (CPC) 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.
Understanding the nuances.
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 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 physicians are very receptive to the education we’ve been providing. A lot of
the time the coders can resolve issues with no experiencing staff shortages, we need for physician input, so had a lot of open positions. Rather we’re reducing the burden on our providers as well as on our coders.”
"The Aptarro support team is so awesome. Any time you have a question, they respond right away with helpful information. Whether by email or over the phone, they're always so easy to work with."
Allowing the team to focus on high-value encounters only.
Rather than having coders check each encounter against a paper list of codes, CPC found HCC Coding to identify critical, high-value HCC encounters that lack specificity, have not been properly captured, or have codes that need to be deleted, allowing coders to make the most of their time and skills.
"The team cut down tedious work. The coders no longer have to manually look for codes, ensuring that we’re coding to specificity,” says Shymeka Lewis, Coding Manager at CPC. By automatically processing encounters that have been correctly coded, CPC also cut down the number of encounters each coder has to check, helping the group grow without having to hire additional staff.
Now, the CPC team has reporting to find common issues their coders were addressing over and over. Like being 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.
That in turn eases 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.
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