Case Study: CommuniCare Health Services achieves $10M+ in RAF improvements with Digital Scientists' AI-powered medical coding platform

CommuniCare Health Services boosts RAF by $10M+ with Digital Scientists

CommuniCare Health Services, a major post-acute care provider, faced a significant challenge with millions in missed revenue due to incomplete medical coding. Their providers were documenting patient conditions in clinical notes, but these diagnoses were not being consistently captured as coded claims, creating a large documentation-to-coding gap across their 20,000+ patients. To close this gap, they partnered with vendor Digital Scientists to develop an AI-powered medical coding engine.

Digital Scientists built a platform that analyzes six clinical data sources to identify missed diagnoses in roughly 60 seconds per patient. The solution integrated with existing EHR systems and provided coders with AI-assisted recommendations, each backed by audit-ready evidence. This resulted in over $10M in Risk Adjustment Factor (RAF) improvements, a 90%+ diagnosis accuracy rate, and a 50x faster patient review process for CommuniCare Health Services.

CommuniCare Health Services