Hierarchical Condition Category (HCC) coding is critical in ensuring accurate reimbursements and improving patient care. eClinicalWorks HCC Solutions offers a seamless, integrated approach to risk adjustment, helping providers close gaps, streamline workflows, and stay compliant with CMS and HHS guidelines. Here are 10 ways eClinicalWorks HCC stands out from the competition.
1. Optimize Reimbursements with Precise Risk Adjustment
eClinicalWorks HCC ensures accurate Risk Adjustment Factor (RAF) scores by integrating demographic data and chronic condition diagnoses. This enables precise healthcare expenditure predictions, ensuring providers receive optimal reimbursements while streamlining patient risk documentation.
Supports Both CMS & HHS HCC Models
2. Identify & Close Coding Gaps with AI-Driven Insights
eClinicalWorks HCC detects coding gaps using historical data and predictive insights. By analyzing previous diagnoses, secondary manifestations, and disease markers (labs, imaging, structured data, and free text), the system presents potential hcc diagnosis codes for clinician review.
Key Features:
Primary/Historical Codes: Identifies previously documented codes that need updating.
Potential Conditions for Evaluation (PCE): AI-powered HCC coding recommendations.
External Data Integration: Leverages PRISMA and payer medical claims.
Suspect Code Management: Accept, reject, or suppress suggested codes for accuracy.
3. Seamless Data Integration for a Unified View
eClinicalWorks HCC synchronizes data from multiple sources, ensuring no crucial HCC risk adjustment insights are missed:
PRISMA
healow Insights
Medical Claims Data
4. Real-Time RAF Score Calculation at the Point of Care
Providers can access instant RAF score updates during patient encounters, enabling proactive care management and regulatory compliance.
5. Interactive Dashboards & Actionable Reporting
A user-friendly dashboard allows providers to:
Analyze RAF score trends over time.
Identify and filter open coding gaps.
Track score fluctuations by provider, practice, and insurance.
Drill-down capabilities help pinpoint high-risk patients for timely interventions.
6. Automated Daily Recalculation for Maximum Accuracy
The system recalculates RAF scores daily, ensuring up-to-date risk adjustment data while minimizing manual errors and improving efficiency.
7. Proactive Patient Engagement for Better Care Optimization
The platform identifies patients without upcoming appointments and prompts care teams to reach out and schedule visits, helping to close gaps and improve outcomes.
8. Sunoh.ai Ambient Listening Technology
One of the biggest hurdles for providers is documenting all necessary hcc coding guidelines during patient encounters. Sunoh Ai’s Ambient Listening Technology is designed to address this. Accurate HCC documentation is crucial for proper risk adjustment and maximizing reimbursement.
Listens and captures conversations between the provider and patient
Generates a dialogue flow
Analyzes the conversation and suggests relevant diagnosis codes, labs, DI, and medications
Creates a clinical document draft, assists with order entry, and provides a summary for review
Sunoh creates a comprehensive clinical draft document in real time, reducing the risk of missing important details. This eliminates what we call “loss of signal,” which refers to details that the provider may overlook or forget.
9. Streamlined To-Do Feature for Provider Efficiency
A dedicated To-Do List highlights unresolved coding gaps, allowing providers to complete documentation efficiently and reduce administrative burdens.
10. Lower Cost of Ownership with Integrated HCC Coding
Unlike third-party solutions, eClinicalWorks HCC is built directly into your EHR, reducing:
Implementation costs
External interface expenses
Data security risks
Why It Matters for Your Organization
eClinicalWorks HCC Solutions delivers a comprehensive, AI-powered, and regulatory-compliant approach to risk adjustment. With real-time analytics, automated recalculations, and proactive patient engagement, it optimizes both HCC coding efficiency and reimbursement accuracy. Stay ahead of evolving CMS & HHS regulations with eClinicalWorks’ HCC (Hierarchical Condition Categories) Solutions.
Ready to simplify your risk adjustment strategy?
Stay ahead of evolving CMS & HHS regulations with eClinicalWorks HCC Solutions.
