SOUTH KINGSTOWN — ChartWise Medical Systems Inc. plans to disrupt the medical coding and documentation industry at the American Health Information Management Convention in Los Angeles with its new Risk Adjustment Factor Calculator which offers outpatient care analysis in its comprehensive cost estimation tool according to the company Monday.
The convention will take place on Oct. 7.
RAF Calculators determine the reimbursement rate for the Medicare Advantage program and other Medicare programs using the Hierarchical Condition Category medical coding billing system, according to the Wolters-Kluwer Health Language Blog.
RAF Calculators use the coding information to assess the relative health of a patient, which suggests the cost to provide care to them. The more accurate the calculator, the less likely a hospital or care center is to lose out on the cost of care provided, said Dr. Jon Elion, founder and CEO of ChartWise Medical Systems.
“We want you to get what you’re entitled to,” Elion said.
Risk Adjustment Factor Calculators typically assess inpatient cost analysis, but leave outpatient analysis to a cumbersome hand-written process, said Elion. Chartwise has added outpatient care analysis built in. That takes a matter of seconds, he said, rather than the months typical of the hand-written process.
“However, as the [coding and documentation] industry begins to contemplate outpatient or ambulatory, different metrics are required. We cover both inpatient and ambulatory—providing both the diagnosis-related groups weight and RAF scores. This is truly a game-changer in the industry,” Elion said.
ChartWise’s RAF Calculator also offers the following features:
- An algorithm for calculating all the current nine Centers for Medicare & Medicaid Services and all of the 30 Health and Human Services Risk Adjustment models
- RAF calculations for patients not currently enrolled in a RAF-based payer plan
- RAF scores available for display and analysis at each stage of the coding and documentation industry workflow
- Functionality designed for a meaningful assessment of chronic conditions, in addition to the acute conditions already addressed by coding and documentation industry
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.