EHR Integrated HCC Coding & Risk Adjustment Guidance at the Point of Care
The HCC Assistant is the only solution that analyzes both clinical and claims information to provide the clinician with HCC coding guidance based on a 360-degree view of the patient’s condition. The HCC Assistant’s NLP-based rules engine performs a prospective analysis of patient information found within the athenaClinicals EHR, as well as a retrospective analysis of submitted medical claims, to instantly identify and close HCC coding gaps.
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How Does it Work?
The HCC Assistant works within the EHR through an easy-to-install browser extension. When clicking on “Go to Exam” in an open encounter, the HCC Assistant runs automatically in the background analyzing patient data. Once the analysis is complete, the provider can click on the HCC Assistant tab to open a slider pane and review HCC recommendations. The provider can then select HCC codes and submit them to be added to the assessment section of the chart in the EHR.
Features and Benefits
- Sophisticated algorithms and NLP analyze structured and unstructured information, while OCR extracts data from scanned documents significantly faster than any clinician or coder
- HCC coding and RAF scoring occurs on-demand and in real-time within the athenaClinicals workflow; HCC codes and supporting documentation can be submitted to the patient’s chart with minimal clicks
- Supporting documentation is validated against MEAT criteria, with each code receiving a clear Pass or Fail grade; validation is essential to making sure that HCC codes are accepted by payers, as well as keeping providers in compliance
- Administrator dashboard helps measure the impact of the HCC Assistant on RAF scoring and tracking usage of the application
HCC Validator Add-On
Inferscience’s HCC Validator takes the guesswork out of chart auditing. Our user-friendly application uses advanced NLP technology to instantly validate HCC codes against MEAT criteria and issues a clear “Pass” or “Fail” grade. Clinicians and coders can now be confident that patients’ ICD-10 HCC diagnoses are captured and validated accurately and thoroughly.
Why do athenahealth customers subscribe to Inferscience’s risk adjustment SaaS products, including the HCC Assistant, in addition to licensing the athenaClinicals EHR? We deliver a hard ROI to medical groups that participate in Medicare Advantage by helping them improve their HCC coding. Our technology allows them to go beyond claims information and analyze the patient’s clinical record to capture more HCC codes faster and more accurately than any other EHR-based application in the marketplace. Providers using our product can expect to increase their patients’ risk adjustment factor (RAF) scores by 0.1 or more, which translates into at least a 10% increase in per-patient funding.
Other Inferscience Products
Inferscience’s Claims Assistant analyzes raw medical and pharmacy claims information to identify missed HCC coding opportunities. It can identify HCC codes that may have been billed by other providers or by the patient’s primary care provider in the previous calendar year. Insights can also be gleaned by analyzing pharmacy claims and lab results. Submission of all appropriate codes gives health plans and Medicare a more realistic assessment of the patient’s condition and projected healthcare expenditures.
Infera is an advanced clinical decision support system (CDSS) that seamlessly integrates with your EHR and the clinician workflow. It provides clinicians with peer-reviewed, evidence-based, clinical recommendations in real-time by analyzing the patient’s EHR data. Infera is a HIPAA compliant and secure solution. Unlike CDS solutions that provide reading lists of articles or clinical summaries, Infera actually helps clinicians practice medicine more efficiently and deliver better quality care.