Whether you’re new to coding or an experienced professional looking to hone your skills, there are many things you need to know about HCC coding. The information in this article will help you identify and treat patients with chronic illnesses, document and code diagnoses, and predict resource use by Medicare Advantage enrollees.
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Documenting and coding diagnoses
If you are a health care provider, you know that the documentation you provide is crucial to ensuring that you are correctly reimbursed. However, some providers may need to become more familiar with the ICD-10 guidelines or how to use the coding system effectively.
To get reimbursed correctly, your provider must document all diagnoses evaluated during each encounter. You must also ensure that the most accurate HCC code is assigned to each diagnosis. The right HCC codes can assure proper payment in Medicare’s alternative payment models.
When you use technology to optimize your documentation, you can improve the coding process and ensure that you capture the most appropriate HCC codes for each patient. With the right tools, your healthcare organization can ensure that you meet your quality and compliance goals.
For example, you could build a clinical dashboard that shows a snapshot of your EMR data. It can help identify patients with gaps in their documentation. It can also help you prioritize what needs to be done to improve coding accuracy.
Ensure an accurate problem list
A problem list is a big deal in the healthcare industry. It provides structured data and a snippet of information you can use to determine the best course of action to take.
In the world of healthcare, an adequately maintained problem list has the potential to improve patient care and qualify your practice for a larger CMS revenue pot. The key is identifying and implementing the right strategies to improve coding accuracy.
Creating an accurate problem list is a task that takes time to complete. As you add new patients and evaluate their histories, your coding team needs to update their inventory accordingly. Identifying and removing inactive diagnoses is a good start.
It’s also worthwhile to ensure your problem-list-mending process is top-notch, as the last thing you want is to be stuck with a problem list containing dozens of duplicate or outdated entries. Fortunately, there are tools on the market to help you ensure your EMR contains only the most up-to-date and relevant patient information.
To find the best solutions for your specific problem, look into the services of a reputable HCC coding agency. These companies offer expert advice, coding training, and consulting services for small and large practices.
Predicting resource use by Medicare Advantage enrollees
The use of risk adjustment models can be used to predict the resource use by Medicare Advantage enrollees. These models allow health plans to determine the appropriate reimbursement for physicians while ensuring that contracted providers have the resources to meet their enrollees’ needs. Studies show that these models can predict spending patterns accurately.
Predictive models have challenged the belief that upcoding is unnecessary. They also help reduce the need to correct risk scores, a technical process. Using predictive methods could help organizations target specific interventions.
The Hierarchical Condition Category (HCC) risk adjustment model is the most commonly used model. This model uses observed risk factors of enrollees to calculate predicted costs. CMS uses it to estimate the future resource consumption of enrollees.
In addition, the HCC model is now being utilized in many state health exchanges for commercial populations. Both these methods have proven successful in predicting resource use by Medicare Advantage enrollees.
Using a data-driven approach, the authors identified five groups of spending patterns. All of these spending patterns were predicted with moderate or vigorous accuracy.
Identifying patients with chronic illnesses who have not been seen in a calendar year
There’s no question that chronic disease affects millions of Americans, and it can be a real drag on a budget. A well-planned program can improve the quality of care while boosting productivity and minimizing costs. The Centers for Disease Control and Prevention’s (CDC’s) website offers a comprehensive look at the state of chronic disease in America. It also provides a list of recommended reading material.
One of the essential components to your success is documentation. For instance, you’ll need to know what your patients are talking about. In addition, you’ll need to know which patients are at risk. Finally, you’ll need to know how to get their attention. Of course, it can be challenging. You can employ various techniques, including scheduling a meeting with the patient, reminding them of your services, or arranging for them to meet you at a different time of day.
Identifying patients with chronic illnesses is the first step in ensuring they receive the best care. However, it’s crucial to identify those patients who need it most, not just those who can be seen in your office.
Hire an HCC RA Coding Specialist
An HCC RA Coding Specialist can assist providers and payers in accurately identifying patients’ risk scores. It can help save money and streamline the reimbursement process.
Medical coders work in hospitals, healthcare facilities, and insurance companies. They must be able to code medical records according to ICD-10-CM and CPT-4 standards. They are also responsible for ensuring regulatory compliance.
In addition to coding, a medical coder must be able to review and analyze the facility’s medical records for supporting documentation. They also must understand how to hold a claim until enough information can be gathered.
A good HCC RA Coding Specialist will have knowledge of the ACA and a variety of risk adjustment models. They will also be able to support HCC data validation audits.
When a provider submits a charge, an HCC RA Coding Specialist can review the information and assign the correct diagnosis codes. Then, they will provide feedback to resolve discrepancies.
When a physician reviews a patient’s medical records, they must complete the documentation correctly. They should always verify the accuracy if they use the copy-and-paste function.