Risk Adjustment Factor Coding Education Services
THN’s risk adjustment department educates physicians and practices on multiple topics related to risk adjustment factor (RAF). We offer a variety of learning options.
- Virtual RAF Academy: An evening meeting with 2 sessions is held quarterly. Taught by THN RAF medical directors, the session provides clinical insight into coding as well as practical advice on how to ensure documentation and coding is accurate, compliant and complete. Physicians may receive compensation for participating and/or continuing medical education (CME) credit.
- Prospective Review: The THN RAF coding educators offer this service to providers to inform them of any outstanding HCCs (diagnosis codes) prior to the patient's visit and to make it easier to capture RAF codes. The process, shown below, is simple.
- Your coding educator reviews your schedule to identify THN members with open opportunities that risk adjust.
- Your coding educator provides you with suspect codes before the member is seen.
- You improve your risk adjustment accuracy and potentially improve patient care by identifying potential chronic conditions still outstanding.
- One-on-One meeting: THN RAF medical directors and coding educators are available for one-on-one discussions with point-of-care providers. We encourage you to take advantage of these opportunities.
Medical Record Review Process
THN is contractually obligated to review medical records on behalf of our payer partners. We use this as an opportunity to capture appropriate risk adjustment codes and use the information to help educate providers and staff on risk adjustment.
We use read-only access to medical records with all the appropriate compliance safeguards in place. Also, we limit the number of team members with access and audit the work done by the team members. We can also accept medical records via secure fax.
Contact the RAF team at THNRAFTeam@conehealth.com for more information about RAF learning opportunities or the medical record review process.
Payer Bonus Programs
- UHC MCAIP: When you participate in this United Healthcare program, you can earn $20 for each suspect medical condition you assess at a care visit with a member. For any members where you address 100% of suspected medical conditions, you can earn an additional $10 for each condition.
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