4 Steps to Improve HCC Coding and Risk Adjustment

Improving HCC coding accuracy requires some steps. One of the most crucial steps is identifying patients with chronic illnesses who are not treated promptly. Other steps include optimizing your EMR, implementing clinical dashboards, and incorporating decision support tools.

Documentation

Proper documentation is essential to the success of HCC coding and risk adjustment programs. To get the best reimbursement, HCC coders must ensure that each patient’s medical record is coded accurately and that the documentation supports the diagnosis. They can achieve this by focusing on the education of the clinicians and integrating appropriate coding into everyday clinical encounters. For example, practices can engage decision assistance tools to help physicians identify active diagnoses. Another option is to implement risk adjustment and hierarchical condition category coding, which alerts the clinician when a patient’s previous code has been assigned to an HCC diagnosis.

Accurate HCC captures can lead to improved patient care and quality scores. However, capturing HCC codes can be challenging for busy clinicians. It is a complex process and can cause human error.

Decision Support

HCC coding is critical for maximizing reimbursement, and improving documentation is the first step. A clinical decision support tool can help physicians identify patients with chronic ailments and ensure that all relevant HCC codes are used. In addition, it helps physicians accurately document patient health and achieve accurate risk scores. These tools can help physicians maximize documentation quality while minimizing administrative burdens.

The process of coding is time-consuming and resource-intensive, requiring healthcare professionals to sift through vast amounts of medical records. The manual process also exposes health plans to a higher risk of human error, costing millions.

Decision support tools use data from medications, symptoms, and labs to make accurate HCC coding decisions. However, the final clinical decision must be made by the provider. These tools can also reduce back-office retrospective work and improve physician engagement.

EMR Optimization

The ability to accurately report HCC diagnoses is critical for ensuring that patients are paid appropriately for their care. Accurate HCC coding is achieved through an efficient documentation process and the appropriate use of data analytics. The EMR can be optimized to improve the documentation process, increase HCC coding accuracy, and improve decision-support tools. Achieving these goals is critical for healthcare organizations, as they can improve reimbursement and provide better care for their complex patient populations.

Achieving HCC coding accuracy requires the education of providers, which should be integrated into daily workflows. Correct HCC coding is crucial to achieving optimal financial results from risk adjustment models. In addition, accurate coding will help physicians better manage patient care, reduce the risk of unnecessary hospital admissions, and create a better annual budget for patient care. It also improves the quality of EMR documentation and supports continuity of care between specialists and PCPs.

Overcoding

HCC coding and risk adjustment are key to Medicare Advantage plans’ reimbursement benefits. The HCC model utilizes ICD diagnostic codes as the primary indicator of a patient’s health status and is used to calculate payments. Accurate coding for Medicare Advantage plans ensures that physician practices submit clean claims for payment.

HCC coding and risk adjustment programs rely on accurate diagnosis coding and complete clinical documentation. Proper documentation improves the quality of care and reduces the risk of over and under-reporting. To avoid losing the opportunity to collect HCC data, healthcare organizations must provide adequate education to providers.