Inferscience offers the best medicare risk adjustment coding technology in Newton, MA. The risk adjustment (RA) workflow process in healthcare is here to stay, and even if organizations are slowly catching up, there are a lot of gaps that need to be closed for it to become more efficient. There are several ways to help providers catch up and improve their workflows that will help their health outcome management and, by and large, improve their RAF scores.

1. Benefits of Reporting Tools for Risk
Adjustment Workflows
The risk adjustment (RA) workflow process in healthcare is here to stay, and even if
organizations are slowly catching up, there are a lot of gaps that need to be closed for it to
become more efficient. There are several ways to help providers catch up and improve their
workflows that will help their health outcome management and, by and large, improve their
RAF scores.
Before we talk about how to improve RA workflow processes, let’s see at a glance some of the
limitations of the old medicare risk adjustment coding workflows according to reports we see
at Inferscience while working with healthcare providers.
Limitations of traditional RA workflows
Inefficient medical record retrieval
Healthcare providers feel very frustrated using medical records generated from risk adjustment
retrieval projects. According to them, “it feels like throwing everything in the air and hoping
things land correctly.” This is because of several factors: the lack of involvement and
commitment from the healthcare team and the barely surviving process of manual RA coding.
Inaccurate data coding
Some of the complaints we hear at Inferscience from healthcare providers, previous to using an
HCC Coding software tool, is the added burden of coding. Coding is a complicated process
because it means having to sort through the ICD-10 codes that are unstructured and disjointed,

2. not to mention the obstacles they face from using incomplete and carelessly reported medical
histories.
Inadequate involvement of the healthcare team
Because the healthcare providers feel that ICD-10 coding is like using a method that is buried
somewhere that would take more than an expert to find, this adds to their lack of involvement
and participation in the RA workflow process. Not to mention the technical issues providers
encounter as the team migrates to a new process.
Now that we have named some of the limitations of traditional RA workflows let’s enumerate
the merits of using new technology-optimized reporting tools in implementing risk adjustment
systems.
Benefits of Reporting in RA workflows
Team accountability
Tools like the HCC Assistant not only make HCC diagnosis codes and HCC medical coding
simpler; they also eliminate the obstacle of guessing who is utilizing the tool. With customized
utilization reporting, the HCC Assistant gives admins daily reports that can be seen by each
provider to review their results or everyone on the healthcare leadership team. This process
raises the satisfaction and ease of use for providers, therefore, earning their participation and
accountability.
Team leadership
Team leadership skills can be strengthened by having the right information to keep the team
accountable for their HCC utilization and leaders can also get a glance at who is collaborating
with the overall goals and workflow.
Team performance
With better team leadership, accountability, and participation, all healthcare providers will
have ease of practice over time. These factors will influence the team’s performance
contributing to better RA scores.
The Future of RA Workflows
A primary key in the future of using automated and/or assisted RA workflows is the team of
providers working together consistently and committedly. Here are some keys to the future of
RA workflows:

3. Interoperability in healthcare
As the healthcare industry landscape rapidly changes, intensified by the Covid-19 pandemic, all
stakeholders need to cooperate to make the system more interoperable. We all know that
post-pandemic, patients have now become advocates of greater and easier access to their
medical records, putting much emphasis on privacy.
On the other side of the spectrum and as the sharing of health data increases, everyone on the
provider side needs to keep up with the demands by emphasizing everyone’s commitment to
first; provide quality care and second ensure access to complete and accurate medical records.
Consent and data segmentation
On top of the need for interoperability, informed consent is crucial to make patients well-
informed and become partners in the responsibility of their health management. Data, on the
other hand, is the sole responsibility of the providers making sure they are handled with utmost
confidentiality yet, not compromising availability to everyone in the care of the patient.
21st Century Cures Act
In March 2020, a big step forward was made as the 21st Century Cures Act was put together by
the Office of the National Coordinator (ONC) for Health Information Technology (IT). ONC,
together with the Centers for Medicare & Medicaid (CMS), finalized the implementing rules for
the Cures Act requiring select payers, health care systems, and health IT vendors to provide
patients access to their data, primarily through Fast Healthcare Interoperability Resources
(FHIR) Application Programming Interface (API). The Cures Act is a significant advancement that
enables patients to easily access their medical records using any app of their choice.
In Conclusion, Collaboration is KEY
It would be an understatement to say that all stakeholders should collaborate to make these
advancement efforts become a success. The building blocks and key drivers were the
frameworks for consent and segmentation, coupled with a strong technology structure.
In conclusion, although many of the provisions in the Final Rule of the Cures Act are highly
technical and are powered by Health IT programmers and developers, physicians and the rest
of the healthcare providers need to comply with making migration into this system smooth for
everyone. Just as important is to keep IT systems and the team updated with the latest
requirements and implementing rules which also happens to be the qualifications of most
Medicare Quality Reporting and Promoting Interoperability programs.