Optimizing HCC Capture in a Geriatric Primary Care Group
- The geriatric practice lost revenue due to missed HCC codes under Medicare Advantage risk adjustment.
- Complex chronic conditions were not consistently documented or recaptured annually.
- Lack of EHR prompts and busy visits led to under-coding and low RAF scores.
- An AI-powered NLP tool flagged uncoded conditions and gave real-time HCC suggestions.
- Providers accepted ~80% of recommendations during the pilot phase.
- HCC capture improved by 25%, RAF scores increased, and reimbursement rose significantly while maintaining CMS compliance.
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- The geriatric practice lost revenue due to missed HCC codes under Medicare Advantage risk adjustment.
- Complex chronic conditions were not consistently documented or recaptured annually.
- Lack of EHR prompts and busy visits led to under-coding and low RAF scores.
- An AI-powered NLP tool flagged uncoded conditions and gave real-time HCC suggestions.
- Providers accepted ~80% of recommendations during the pilot phase.
- HCC capture improved by 25%, RAF scores increased, and reimbursement rose significantly while maintaining CMS compliance.