The COVID-19 pandemic has disproportionately affected the healthcare industry. The dynamics are difficult to determine, even within the healthcare arena itself. Practices are suffering from vastly reduced patient visits, and hospitals are being crushed with sick patient overload.


CareOptimize has been helping clients overcome challenges and develop solutions for over a decade. That knowledge base enabled us to quickly craft solutions to industry challenges.


HCC Coding

Hierarchical Conditional Category – Diagnosis codes selected by CMS that are used to create a patient’s risk (RAF) score and correlating reimbursement amount. Improve reimbursement by incorporating the documentation of HCC’s into your workflow, based off accurate risk scores.

    • Training to identify & appropriately select HCC codes – sourced from current provider, specialists, hospital discharge summaries, lab results and diagnostic results.

    • Point of care HCC coding guidance.

    • Coding review processes between providers and coders prior to claim creation.

    • Custom extractions from additional sources sent to payers.

    • Shows claim and reporting data imported into the EHR.

    • Identification of suspected codes.

    • Alerts user to overdue codes and drop-offs.

    • Reports tracking provider utilization.

    • Post visit coder training – review chart notes to ensure relevant HCCs were documents during the visit, were coded to the highest level, and have a corresponding plan of care.


In the very early stages of the pandemic, it became clear the two greatest challenges were practices being able to monitor their patients and report COVID-19 cases.

CareOptimize employed utilities in our service-as-software Analitico Quality Module to identify high, medium, and low-risk COVID-19 patients and place them in a report for easy discovery. Simple, quick identification of patients’ risk levels helped clients continue care management programs and pinpoint and monitor any patients with additional conditions.

Along with the report, CareOptimize developed a template for logging in data on patients who tested positive. This tracking could be a cumbersome, multi-faceted process. The template we developed streamlined notifications on those patients to the CDC, state health agency, and/or local health department.

Telehealth is an answer to practices suffering from reduced patient load. With expanded definitions and relaxed restrictions, telehealth has become the primary avenue for patient and provider contact. CareOptimize helps clients navigate the constantly changing regulations, ensuring all understand the opportunities and limitations.


COVID19 loans to grants have been instituted by CMS and large insurers. We know our clients have enough to deal with without having to read and comprehend the fine print associated with the loans and grants. We put together free written instructions on how to access and apply for the Advanced/Accelerated Payments. If a practice desires more hands-on help, CareOptimize works alongside them to assure all details are addressed and applications sent in a timely manner.




Your Message