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Concurrent Review RAF Score For CY2024
| S.No | ICD 10 CM Code | Flag | CMS-HCC-V24 | CMS-HCC-V28 | Diagnosis Description | Delete Record |
|---|---|---|---|---|---|---|
| 1 |
| Category | CMS-HCC-V24 | CMS-HCC-V28 | CY2024 | |||
|---|---|---|---|---|---|---|
| ICD10 | HCC | HCC | Pre-Audit | Post-Audit | ||
| RAF Score | MA Payment | RAF Score | MA Payment | |||
Improving Real-Time Patient Care and Revenue Optimization
By conducting a concurrent medical record review of medical records, healthcare providers can ensure that treatments are in line with best practices and meet regulatory requirements. This process not only enhances patient care but also supports financial sustainability through precise risk adjustment and optimized reimbursements.
What is Concurrent Review?
A concurrent review involves assessing a patient’s medical records and treatment while the patient is still receiving care. This real-time evaluation allows healthcare providers to address any discrepancies or make necessary adjustments to improve the quality of care. Concurrent medical record reviews focus on coding accuracy and documentation to ensure that everything complies with standards, which is especially crucial for chronic conditions and risk adjustment.
Identifying Documentation Issues
Concurrent coding works alongside fee-for-service E&M coding to capture essential Hierarchical Condition Category (HCC) medical diagnoses. These diagnoses must meet MEAT (Monitoring, Evaluation, Assessment, and Treatment) criteria to ensure accuracy.
By identifying HCC-related conditions in real-time, concurrent coding allows for more precise risk adjustment, leading to more accurate reimbursements and additional revenue for healthcare providers managing chronic conditions.
Enhancing Clinical Documentation Improvement (CDI)
One of the significant benefits of concurrent review is its impact on Clinical Documentation Improvement (CDI). Accurate coding is essential for ensuring that the necessary medical diagnoses are documented and reimbursed. Concurrent review supports CDI by identifying high-revenue HCC/ICD codes that may need better documentation. This proactive approach allows providers to improve the quality of documentation while maintaining compliance with MEAT criteria.
Concurrent review audits ensure that the review process is thorough and consistent, improving the accuracy of CDI efforts. These audits also generate monthly reports of ICD codes from a doctor’s patient visits, allowing healthcare providers to monitor their coding practices and address any gaps in documentation.
Streamlining Physician Workload
A key advantage of concurrent review audit is its ability to reduce the workload on physicians by flagging 'Deleted' or 'Added' ICD codes that require attention. This approach minimizes the administrative burden and enables doctors to focus on patient care rather than documentation. The system can generate cumulative reports by ICD code or patient, including the Top 10 diagnoses and patients, which simplifies the review process.
