To achieve financial success under today’s value-based programs, it’s imperative that your patients’ health status be appropriately risk adjusted—and that can only happen if your organization is accurately and completely capturing and documenting HCC codes for every enrollee.
But what is the best way to make that happen?
The basic principle is simple: capturing robust data reduces errors and leads to more accurate profiles. But performing this process—which is highly dependent on your physicians—can be challenging.
To make it easier, we’ve broken down the HCC coding process into three simple steps.
Step One: Pre-Visit Planning
Performed prior to the patient’s arrival, this proactive process helps your physicians prepare for their busy day by identifying those patients with chronic conditions (“HCC patients”) who need additional attention before they enter the exam room.
All physicians want to provide great care for their patients, of course, but their schedules are busy and their time is in high demand. A long history of fee-for-service has conditioned them for high patient volumes, and they typically move as quickly as they can from exam room to exam room.
But today’s shift to value-based programs is demanding a more proactive, coordinated approach to care, making physicians’ responsibilities more complex and nuanced—and requiring that they be prepared with as much up-front information about their patients’ medical conditions as possible.
Most organizations are finding that their physicians need additional support in this process, and many are providing human resources, such as care coordinators or nurse navigators, to help physicians identify and understand those patients who need extra attention and focus. Identifying HCC patients with chronic conditions ahead of their visits makes activities such as chart prep, problem list reviews, and morning huddles more effective and targeted.
Leveraging technology to automate the identification of HCC patients on the physician’s schedule can help the care team target their efforts more accurately and consistently—while saving substantial amounts of time and money compared to hiring additional staff.
Step Two: Pre-Claim Coder Review
This part—after the patient has been seen and the doctor has recorded his or her notes in the EMR —is vitally important, as it impacts diagnosis specificity, the selection of HCC code(s), and ultimately your organization’s reimbursement under value-based programs.
The human challenges of HCC coding are largely the same as those faced in the fee-for-service world. For physicians, providing great care and supporting that with robust clinical documentation is demanding enough. Expecting them to become coders is unrealistic.
That makes a robust and thorough review of all HCC codes before claims are submitted essential. Yet hiring additional coders to manually review every chart is likely to be prohibitively expensive.
The solution is to leverage available software tools and technologies—which have been proven over the years under fee-for-service—to automate the pre-claim review process.
Step Three: HCC Benchmarking
The final step, HCC Benchmarking, brings insights and awareness to your overall program metrics and performance.
Because the risk adjustment calculation process lags behind patient encounters, it’s imperative that organizations know where they stand throughout the year by using real-time data to understand recapture rates, trends, education gaps, and opportunities.
Successful benchmarking under value-based programs requires a reorientation of existing reporting systems and dashboards—and a shift of mindsets and focus from RVU and productivity metrics to reporting on complete and appropriate documentation and the capture of diagnosis codes.
This shift in perspective empowers organizations to understand the value of captured HCCs while identifying areas of success and opportunities for improvement.
IN SUMMARY
Organizations that succeed in putting all pieces of the HCC capture process in place are realizing measurable improvements in risk scores—and doing their part to ensure that the funds they need to provide care for these patients are appropriately assessed and fully allocated.
For more in-depth information on tackling and taking control of the HCC capture process, watch our on-demand webinar—HCC Coding: 3 Steps to Operational Success—today. And learn how Signature Healthcare, an award-winning medical group, successfully adjusted their workflow to meet the demands of value-based contracts.
