ChartWise Medical Systems, a provider of computer-assisted clinical documentation improvement (CACDI) has announced the launch of its new Risk Adjustment Factor (RAF) Calculator which puts hospitals and medical centers in the best possible position to assess and maintain an accurate patient risk profile.
For CACDI, the better a hospital or medical center can document HCCs, the higher the possible RAF scores and the higher the reimbursement. While similar to Diagnosis-Related Groups (DRGs), RAF scores apply in the ambulatory setting as well as the inpatient setting, and that’s the best place for ambulatory CDI to focus their efforts.
ChartWise’s new RAF Calculator technology is extremely valuable in today’s healthcare environment for a multitude of reasons, including:
– Using Risk Adjustment to drive reimbursement started with Medicare Advantage plans, and is showing up in an increasing number of insurance plans
– Risk Adjustment models predict health care costs of patients
– The RAF for a patient has been difficult to calculate, and not generally available in a timely fashion
– Real-time availability of the patient’s RAF score turns it into a valuable means to measure the impact of CDI, both inpatient and ambulatory
– RAF scores provide healthcare facilities a solid Key Performance Indicator (KPI) to measure and drive ambulatory CDI success
“To date, CDI has focused on the inpatient population, using DRGs to determine reimbursement, and Severity of Illness (SOI) and Risk of Mortality (ROM) to identify how sick a patient is,” said Dr. Jon Elion, founder and CEO of ChartWise Medical Systems in a statement. “However, as the CDI industry begins to contemplate outpatient or ambulatory, different metrics are required. We cover both inpatient and ambulatory—providing both the DRG weight and RAF scores. This is truly a game-changer in the industry.”
