Review HCC risk capture and coding gaps
Drafted from the screen's code on main (kareIntelligence 7455702). Not yet reviewed against a live session. Roles listed are the defaults the app's role matrix (@collabkare/ability 0.12.0) gives this screen's route; your organization's role overrides can change them.
Quality & Risk → Risk Capture shows RAF scores, HCC coding gaps and the recapture opportunity by PCP. Scores use a v1 flat CMS-HCC V24 subset model, and the header says so. Choose the Payment year at the top.
Tabs
- Performance — attributed patients, average RAF (current, with prior and year over year), patients with gaps and the number of open coding gaps, prior / current / potential RAF, and per-PCP RAF and recapture. A Clinical measures (CR lane) strip shows CQL-evaluated HCC measures.
- Distribution — members per RAF band, prior against current year, and open gaps by HCC condition. Click a bar to inspect the condition.
- Patient Detail — attributed members sorted by recapture opportunity (potential − current). Expand a row for the gap drill, including the prior-year evidence.
- Patient Gaps — open coding gaps by HCC, highest total value first, then the worklist candidates list (highest recapture delta first).
Terms
- A coding gap is a prior-year HCC not re-documented this year.
- Potential RAF assumes every open gap is re-documented this year. The lift over current is the recapture opportunity.
Acting on the roster
On Patient Gaps, select members in the worklist candidates list and choose Send n member(s) to recapture worklist to post their open gaps to kareManager (one work item per member and HCC). Where outreach drafting is switched on, the Patient Detail roster also has a Draft outreach action for one member; the draft waits in Outreach drafts and nothing is sent.
Things to know
- If the worklist service is unavailable, nothing is created, and the screen says so.
- The model is a subset model; treat RAF as a relative measure within your population.