![]() ![]() Measuring outcomes provides healthcare organizations with compelling data to present to stakeholders, such as an increase in average RAF score, an improvement in crucial problem list diagnoses, a decrease in the number of members who do not have an annual visit, and an increase in the percentage of persistent condition diagnoses resolved. To ensure an accurate problem list, remove duplicate and inactive diagnoses, identify critical areas with discrete data in the EMR, and prioritize results using a diagnosis preference list that includes HCC suffix codes and RAF values. Preparation of an Accurate Problem Listįor years, many healthcare organizations have been entering data into an EMR, resulting in a large amount of data and, most likely, an inaccurate problem list.Some potential strategies include ACO identifiers in the EMR, decision-support tools that can be activated for specific populations, and HCC diagnosis alerts for past codes. Improve Decision Support with EMR OptimizationĪlthough provider education is necessary to improve HCC coding accuracy, it is also critical to incorporate appropriate coding into the daily encounter workflow.At the system level, education should focus on the importance of appropriate risk adjustment and impact quantification to justify resource allocation, as well as compliance. They can also be educated on the specifics of the tools and workflows for patient management and reporting. The providers can be taught about the clinical and monetary value of specificity. The most crucial educational point to emphasize to providers is the importance of accuracy, not the score itself. To be captured for risk adjustment, documentation for a valid diagnosis should provide evidence of how the condition is monitored, evaluated, assessed, or treated (M.E.A.T.).Īs HCC coding is a new concept far from intuitive, educating clinicians along the way is critical. ![]() Treatment: Medication, therapies, and other treatment options.Assess: Ordering tests, discussion, reviewing records, and counseling.Evaluate: test results, medication effectiveness, and treatment response.Monitor: signs, symptoms, disease progression, and disease regression.Each encounter should be treated as distinct and in accordance with M.E.A.T. The only way to support a diagnosis for a face-to-face visit is via M.E.A.T. Therefore, it is crucial to implement the following strategies to improve the HCC coding performance: Inaccurate risk classification has significant financial implications for the potential payments your healthcare organization will receive. If your patients are not correctly coded, your patient panel may be assigned to the incorrect risk group. Thereby, HCC accuracy impacts program success, especially for innovative programs such as Primary Care First. As a reminder, HCC coding enables providers and billing/coding teams to account for future health risks and costs at the patient level. Understanding HCC coding has become critical for healthcare organizations to succeed in new payment models as we transition to value-based care.
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