01
HCC Detection
Suspected, undocumented HCC conditions surfaced from chart notes, claims, labs, and historical encounters, so nothing slips through a single data source.
HCC / RAF Gap Detection
We find the HCC conditions hiding in your data and show you exactly what they’re worth in RAF, scored against CMS-HCC V28, before the performance year closes.
The complete HCC and RAF gap-detection capability set
The full set of capabilities for identifying suspected HCCs, scoring RAF against CMS-HCC V28, and maintaining audit defensibility across every code.
02
Risk Gap Analysis
Open risk gaps ranked by RAF impact and clinical urgency, so your team works the conditions that move risk score and revenue first.
03
Coding Optimization
Undercoded encounters and missed specificity surfaced and ranked by impact, with every suggestion clinically-indicated, never generic upcoding.
04
Documentation Mapping
Every HCC suggestion mapped to MEAT-supported chart evidence (Monitored, Evaluated, Assessed, Treated), so documentation holds up under RADV audit.
05
CMS Alignment
RAF scored continuously against current CMS-HCC V28 model logic like current, projected, and trended, so you’re always aligned to the model that pays you.
06
RAF Enhancement
Suspected HCCs surfaced inside your EHR before the encounter, so conditions get documented in the room and RAF lifts in the current performance year.
The HCC and RAF gap-detection implementation journey
Four steps that take you from EHR and claim connection to live HCC detection and continuous RAF scoring.
1
Connect EHR + Claims
SMART on FHIR + 837/835 claims via your clearinghouse. Connected in 1–3 days, with HCC suspecting running across charts, claims, and lab data within five.
2
Calibrate & Baseline
We establish your RAF baseline against 24 months of historical claims, confirm your patient panel, and tune suspecting logic to your population and CMS-HCC V28.
3
Pilot & Train
Suspected HCCs surface pre-visit for a pilot clinician group, coders work an audit-defensible queue with MEAT evidence, and quality reviews member-level RAF gap lists.
4
Full Rollout + Measure
All clinicians, panels, and payer contracts go live. Your dashboard tracks RAF lift and captures HCC revenue vs. opportunity, quarter by quarter, with attribution by source.
The numbers behind accurate, defensible RAF
How much RAF eCareRevenue surfaces and how defensibly across the orgs running it.
+0.27
RAF lift in one year
Cascade Health Partners ACO moved RAF from 0.94 to 1.21 in a single performance year
CMS-HCC V28
Aligned RAF scoring
Continuous scoring against the current CMS-HCC model logic, current, projected, and trended
100%
HCC suggestions MEAT-backed
Every suspected condition tied to chart evidence (Monitored, Evaluated, Assessed, Treated) for RADV
4 sources
HCC detection coverage
Suspected conditions surfaced from chart, claims, labs, and historical encounters
Frequently Asked Questions
Answers to the most common questions about how eCareRevenue surfaces HCCs and scores RAF.
It analyzes chart notes, claims history, lab results, and prior encounters to surface conditions that are clinically supported but never coded this year. Because it draws on four data sources instead of one, it catches suspects a single-source tool would miss — and shows the evidence behind each one.
Yes. eCareRevenue scores RAF continuously against current CMS-HCC V28 model logic, and shows your score current, projected, and trended over the performance year. You’re always aligned to the model that determines payment, not last year’s logic.
Retrospective tools chase conditions after the visit, when 40% of recapture is already lost. eCareRevenue surfaces suspected HCCs before and during the encounter, so they’re documented in the room and captured in the current performance year, not the next one.
Yes. Every suggestion is linked to MEAT chart evidence like Monitored, Evaluated, Assessed, or Treated, so your audit trail is built as conditions are documented. If RADV comes, the supporting evidence is already attached, not reconstructed under pressure.
No. eCareRevenue only surfaces conditions that are clinically-indicated and supported by evidence in the record, never generic upcoding heuristics. Every suspect is traceable back to the chart, claim, or lab signal that triggered it, so clinicians can verify before they document.
Most customers connect via SMART on FHIR or 837/835 claims in 1–3 days, with HCC suspecting running within five. After we baseline your RAF against 24 months of history, you’ll see open gaps ranked by impact in the first weeks.
In 30 minutes, see how much RAF you’re leaving on the table.
We’ll run HCC detection on data that looks like yours, show you the RAF you’re missing, and answer everything, before you commit to anything.