Most value-based care providers are not equipped with all the tools they need to deliver the best possible care to their patients.
This isn’t the providers’ fault; it’s the result of a broken system that leaves them with too little time to spend with patients and an incomplete understanding of patients’ medical histories and current needs.
And with the phase-in of HCC-CMS V28, it’s more important than ever to equip providers with a comprehensive understanding of patient medical histories and the tools they need to risk adjust accurately.
How Credo PreDx is Supporting VBC Providers in 2024
At Credo, we’re tackling the medical records problem head on with the industry’s first pre-encounter patient summary solution, Credo PreDx.
We’ve seen PreDx deliver enormous value for providers by saving time, improving risk adjustment accuracy, and identifying additional diagnoses to increase reimbursement opportunities.
In fact, a validated case study from Wakely Consulting Group found that using Credo led to an average risk score increase of .445 under HCC-CMS V24, and an average increase of .286 under HCC-CMS V28.
One of the ways we achieve this is by supporting providers in shifting their medical records analysis workflows, so they can start risk adjusting before the first visit. Here are 3 key ways the shift to pre-encounter record analysis benefits VBC providers:
3 Benefits of Pre-Encounter Risk Adjustment for Value-Based Care
1. Maximize Time with Patients
With limited time to spend with each patient, it’s absolutely vital that providers walk into a clinical encounter with a prior understanding of the patient’s history. Unfortunately, traditional processes for retrieving and analyzing medical records tend to start after the clinical encounter.
Credo PreDx’s pre-encounter analysis empowers providers to analyze a patient’s medical history and past diagnoses — in a digestible, easy-to-read format — before meeting with the patient. Then, they can use their time with the patients to confirm diagnoses and address current concerns, rather than playing catch up.
We’re confident this shift will dramatically improve patient outcomes without driving up costs for the provider.
2. Identify Diagnoses for Accurate Risk Adjustment
Now that CMS is eliminating more than 2,000 ICD-10 codes with the implementation of HCC-CMS V28, it’s more important than ever for Medicare Advantage providers to accurately identify all possible patient diagnoses.
Incorrect or unsupported diagnoses can result in payment retraction or fines during Risk Adjustment Data Validation audits, but overlooked diagnoses will adversely affect provider premiums.
Credo PreDx makes it easier to accurately catch and document all possible diagnoses, helping providers remain compliant and minimize revenue corrections.
3. Reduce Time and Money Spent on Chart Chasing
U.S. healthcare spends $125B every year on medical record retrieval and management, but it doesn’t have to be this way.
This is largely because providers are still relying on mail and fax to send and receive records, and a lack of interoperability across different EHRs means that many records arrive in confusing or altogether unreadable formats.
At Credo we’re leveraging AI in partnership with human coders to transform these documents into a readable, easy-to-access patient summary.
By automating the medical records retrieval and analysis process, we’re significantly decreasing costs for our provider customers, and saving clinical staff an average of 1-2 hours per day.
Make the Switch to Pre-Encounter Record Analysis
With V28 already beginning to phase in, now is the time to make sure your risk adjustment process is allowing for maximum accuracy and compliance.
To learn more about Credo PreDx and the value we’re delivering to value-based care providers like you, schedule a demo with a member of our team.
