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Prospective 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 | All | Current Year | HCC | All | Current Year | All | Current Year | ||||||
| RAF Score | MA Payment | RAF Score | MA Payment | RAF Score | MA Payment | RAF Score | MA Payment | RAF Score | MA Payment | RAF Score | MA Payment | |||
Understanding Prospective Review or Prospective Audit in Healthcare
Ensuring accurate diagnosis coding is critical for financial and operational success in healthcare. One of the most effective strategies for achieving this is through prospective review, a process that helps physicians prepare for upcoming patient encounters. Let’s discuss the importance of prospective audits in healthcare.
What is a Prospective Review?
A prospective review is a preemptive approach in which certified coders with clinical knowledge review a patient’s condition history, medications, hospital records, lab results, and physician notes before a patient’s appointment. This review aims to identify any prospective gaps in documentation and coding, ensuring that all relevant HCC (Hierarchical Condition Category) conditions are accurately captured. By doing so, physicians can be better prepared for patient visits, ultimately enhancing the quality of care.
Benefits of Prospective Review or Audits
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Improved Documentation Accuracy:Prospective reviews ensure that all relevant
conditions are documented accurately, reducing the likelihood of missed or incorrect
diagnosis codes.
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Reduced Administrative Burden: By addressing prospective gaps in documentation before
the patient visit, physicians can concentrate more on patient care than administrative
tasks.
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Financial Efficiency: Accurate coding and documentation through prospective audits
can lead to more accurate claims submissions. This accuracy reduces the need for
retrospective reviews and potential claim rejections, ultimately enhancing financial
outcomes.
Implementing Prospective Reviews in Healthcare and Usage of Tools
Implementing a system of prospective reviews and audits in healthcare requires collaboration between coders and healthcare providers. Training and education for coders and providers are super-important to ensure a smooth and effective process. In addition, integrating prospective review practices into the workflow can help identify and address prospective gaps early.
We’ve designed a tool that can help calculate the RAF Score for prospective reviews. Our prospective risk adjustment tools can be used to select high-risk populations for prospective review. By utilizing ICD codes, gender, age, and the assessment year, these tools identify high-risk patients. With the reviewed data, our tools prioritize high-risk disease conditions, enabling physicians to focus on the most urgent cases immediately and efficiently
You can use our risk adjustment tools to calculate the RAF Score for prospective reviews.
Sign Up to Access the Prospective Review Tool
Sign up today to access our powerful tool designed to streamline the prospective review process. Gain accurate insights, improve documentation, and optimize RAF score calculations effortlessly. By integrating this tool, healthcare providers can enhance patient care, reduce administrative burden, and boost financial performance through efficient, data-driven decision-making.
