ACO compliance solution
AI risk adjustment, reporting, and revenue integrity for ACOs
QuickRCM works alongside your existing EHR to ingest clinical and coverage data, capture HCC/RAF opportunities, flag recapture gaps, score denial risk, schedule operational reports, and keep an audit trail for compliance review.
Evaluation problem
ACO compliance depends on connected clinical, claims, and audit workflows
ACO teams are judged on quality, cost, documentation, payment integrity, and operational follow-through. QuickRCM gives those teams a shared workflow for the data that moves from the EHR to coding, risk adjustment, claims, reports, and audit review.
Risk-adjusted populations depend on complete, defensible HCC capture.
Quality, claims, eligibility, denials, and revenue data often live in separate work queues.
ACO operators need scheduled reports and source-level drill-downs without spreadsheet rebuilds.
Denied or risky claims need to be corrected before they affect cash, attribution, or reporting.
Compliance teams need role-based access, audit history, and evidence that decisions are traceable.
Product workflow
From EHR ingestion to reportable ACO evidence
QuickRCM is not an EHR replacement. It coordinates the revenue and risk workflows around your EHR: coverage verification, coding review, HCC capture, denial prevention, claims status, analytics, scheduled reports, and audit evidence.
Review eligibility workflows
Ingest the chart
EHR Integration pulls patients, encounters, notes, coverage, and charges into QuickRCM on a configured cadence.
EHR IntegrationVerify coverage and code
Eligibility confirms active coverage while QuickCode reviews attested documentation, suggested codes, scrub results, and HCC mappings.
QuickCodeCalculate RAF and find gaps
Risk Adjustment applies CMS-HCC rules, surfaces recapture gaps, supports human review, and records final scores.
Risk AdjustmentPrevent denials and submit
Denial Prevention scores draft claims before Claims Submission builds, scrubs, routes, submits, and tracks 837 status.
ClaimsReport and audit
Analytics and Reports create drill-down views, scheduled PDFs or CSVs, delivery logs, and exportable evidence.
Trust CenterRisk Adjustment / HCC
Defensible RAF workflows for risk-bearing populations
The Risk Adjustment module turns validated diagnosis data into HCC and RAF outputs that can be reviewed, traced, approved, sent to Claims for Medicare Advantage submission, and written back to the EHR as a structured risk profile.
ICD-10 to HCC crosswalk with CMS model version, hierarchy handling, and demographic validation.
Human Review Queue for borderline or high-impact HCC decisions before finalization.
Recapture Gaps view for patients who had an HCC last year but not yet this year.
Traceable output tying captured HCCs to source encounter, ICD-10, model version, hierarchy decision, and reviewer context.
Analytics & Reports
Operating views and scheduled reports without spreadsheet rebuilds
Analytics gives ACO operators dashboard views across revenue and clinical-adjacent workflows. Reports assembles cross-module PDF or CSV outputs, schedules delivery, and keeps delivery history for compliance and leadership review.
Dashboards pull from eligibility, coding, claims, denials, payments, AR, and appeals snapshots.
Each dashboard supports filters, CSV export, and drill-down to source claims, encounters, or remittance lines.
Reports are read-only, can combine multiple modules, and can be delivered as PDF, CSV, or both.
Scheduled reports include run history and delivery logs for recipient and audit review.
EHR Integration
Work alongside the EHR instead of duplicating the chart
EHR Integration moves patient, appointment, clinical note, coverage, and charge data into QuickRCM automatically. It can write back eligibility results, finalized codes, claim status, payments, statements, and risk profiles to keep the source chart aligned with revenue-cycle work.
Integration controls documented in the manual
- Configured inbound polling and outbound queues.
- Field mapping editor with sample testing.
- Conflict workspace with side-by-side resolution.
- Sync log, health dashboard, and manual write-back.
Claims / Denial Prevention
Catch claim risk before it turns into denial work
QuickRCM connects Eligibility, Denial Prevention, Claims Submission, Denial Management, and Analytics so risky claims are scored, fixed, assigned, submitted, tracked, and learned from.
Eligibility sends verified payer and coverage context downstream before the claim is built.
Denial Prevention returns risk levels, fixable findings, one-click suggested fixes, assignments, and documented overrides.
Claims Submission builds 837P, 837I, or 837D files, runs scrub stages, routes through Availity or Stedi, and tracks 277 status.
Denial Management turns payer denials into owned cases with root cause, dollar value, routing decision, and EHR memo write-back.
Security / Audit
Trust controls for role-based ACO operations
Organization and RBAC form the trust root for QuickRCM. Permissions, organization scoping, approval gates, delivery logs, HCC review history, claim overrides, and EHR sync events give compliance teams concrete records to review.
Role-based access controls keep users scoped to the work they are allowed to perform.
Feature toggles, access changes, overrides, approvals, and sensitive actions write audit entries with actor and timestamp.
EHR Integration uses encrypted credentials, sync logs, conflict resolution, and write-back traceability.
Report delivery, HCC review, claim scrub overrides, and denial case state changes remain reviewable.
Manual-backed proof points
Workflow records your team can inspect
The supported proof on this page is module-level behavior documented in the QuickRCM manual: traceable HCC outputs, read-only reports, scrub histories, denial cases, and audit logs.
Risk adjustment traceability
HCC outputs are tied to source documentation, model version, hierarchy logic, and reviewer state instead of unsupported revenue claims.
Reporting evidence
Dashboards and scheduled reports are read-only views with filters, exports, run history, and source drill-down.
Claim controls
Scrub findings, prediction results, corrected claims, denials, appeals, and write-offs stay attached to owned workflow records.
Frequently Asked Questions About ACO Compliance
Evaluate QuickRCM for your ACO workflow
Bring your risk adjustment, claims, EHR integration, analytics, scheduled reporting, and audit review requirements to a QuickIntell product specialist.