Increasing Reimbursement by 6.1% by

Improving Risk Adjustment Factor (RAF) Accuracy

The Problem

Vee Healthtek was approached by a large hospital in the Northeast that was experiencing significant gaps in clinical documentation, which resulted in the under-capture of HCC conditions. Due to these documentation gaps, its average RAF score did not represent the true risk profile of its patients.

The under-capture of HCC conditions meant that the hospital was not only missing out on reimbursement but was also lacking a true understanding of its patients’ health. The hospital knew it needed to address this issue to ensure accurate risk assessments, so it came to Vee Healthtek, a leader in risk adjustment factor optimization known for accuracy, quality, and compliance, to improve its reimbursement and better understand its patients’ health needs.

Our Solution

Vee Healthtek’s HCC experts performed a thorough review of the hospital’s medical records to assess the providers’ documentation practices. After noting missed HCC conditions and rectifying documentation gaps, our team provided detailed feedback to the providers through our customized clinical documentation improvement (CDI) program. Focusing on the issues we identified, we reviewed best practices for documentation accuracy and completeness.

To ensure the effectiveness of our CDI solution, we conducted frequent audits and reviews to track key performance metrics such as RAF scores, documentation completeness rates, and reimbursement outcomes. These audits were designed not only to measure progress but also to identify areas for additional attention during training.

We also provided the client with comprehensive reports and data-driven insights to demonstrate the providers’ progress and identify opportunities for RAF optimization. By leveraging these insights, the hospital could benchmark its performance against industry standards and implement changes that would lead to better patient care and financial stability.

The Value

By partnering with Vee Healthtek, the hospital not only boosted its financial performance but also enhanced the overall quality of care provided to its patient population as a result of the more accurate RAF scores.

The improved HCC condition capture provided a more comprehensive representation of the patients’ risk profiles, allowing for better risk stratification and care management. Most impressively, the hospital saw an impressive 6.1% increase in reimbursement as a result of the increased average RAF score. The hospital was especially thrilled by Vee Healthtek’s approach to provider education, which significantly decreased documentation gaps. The client noted that its providers became highly proficient in documenting relevant HCC conditions as a result of our CDI program, which led to better coding accuracy and completeness.

Overall, Vee Healthtek’s solution was a turning point for the hospital, enabling it to overcome existing documentation deficiencies and build a robust framework for sustained improvements in documentation and risk adjustment. This strategic collaboration positioned the hospital for long-term success, ensuring that it could continue to provide high-quality care while also maintaining its financial health.