Allscripts CQS HCC Channel

The Allscripts CQS Powered by TeamPraxis can save physicians participating in Medicare Hierarchical Condition Category (HCC) thousands of dollars each year by ensuring that their Risk Adjust Factor (RAF) score accurately reflects the disease burden of their patients. Since RAF scores reset at the beginning of each year, physicians must recapture each diagnosis for every patient to protect their score. While this creates a good incentive for physicians to follow up with their most ill patients, it can have the unfortunate side effect of decreasing their rightful CMS reimbursement, if a physician inadvertently fails to recapture a diagnosis code or selects an insufficient one.

CQS protects physicians’ RAF scores by bringing HCC code recapture to the point of care, virtually eliminating costly code omissions. Pulling patient data from the physician’s EHR and PM systems, CQS runs this data through an intelligent rules engine that cuts through all the “noise” and determines appropriate diagnosis codes. When these diagnosis codes are not present in a patient’s electronic chart, (either signifying that it needs to be recaptured or an insufficient code has been documented), CQS places an alert in Enterprise EHR, prompting the physician to take specific actions.

CQS makes HCC reporting less burdensome for clinical quality staff and reinforces the value of proper HCC coding. CQS allows physicians to see a prioritized list of the patients who are missing diagnosis codes that need to be readdressed. Also, alerts prompt physicians to address missing diagnosis codes at the point of care, which also reduces the workload for clinical quality staff minimizing the need to pull charts on the back end to recapture HCC codes.

Contact your Allscripts Client Sales Executive with any product questions and/or inquiries.