We’re all familiar with the staffing challenges facing the healthcare industry. A staggering 79% of health care professionals say the national worker shortage has affected them and their place of work. HCC capture is complex at the best of times and is even more likely to fall through the cracks during times of staffing challenges.
At RCxRules, we work with many groups who need to find creative ways to achieve maximum impact with minimal staff hours. One medical group we recently worked with is a great example of how a combination of technology and skilled resources can equal success. When faced with staffing challenges, this medical group decided to leverage technology to maximize their efficiency while working towards hiring a coder. While they searched for a skilled resource to onboard, they had to think about how best to strategically manage and monitor HCC capture.
We worked closely with their team to determine what technology they had in place that we could leverage—and then expanded upon this technology by implementing our HCC Coding Engine. The HCC Coding Engine’s targeted HCC coding rules enabled this group to focus their efforts on high-value encounters and make the most of their time.
We guided them through the following process. First, they identified which of their patient encounters had the most financial risk, which we refer to as filters. In this case, the financial risk was in their new MA plan. Then we applied criteria to monitor these high-risk encounters by visit type and condition history. In this case, we chose level 3,4, and 5 E&M and wellness visits, as well as patients with a history of diabetes and hypertension. We also focused on unspecified code review and opportunities for combination codes.
We then needed to set up a monitoring system to understand their performance and prioritize their resource requirements. We started off by setting up rules that tracked the number of tasks that would have been distributed to the coder. This allowed them to understand and refine their filters, get early indications of missed coding opportunities, and gear up to bring on their new coding resource.
When they were finally able to bring on a skilled HCC coding resource, they were able to simultaneously train them on both the technology and the process since everything was already in place. This meant that on day one, their new hire was able to start performing the concurrent HCC coding review process for those targeted encounters.
In week one this group’s single coder started out performing 38 reviews in day, and they worked up to a high of 92 reviews per day. They were consistently able to make an impact on these encounters—one out of every three encounters needed a code to be added, removed, or changed due to the documentation being better than the coding. The net result of those changes equates to $1.1 million in gross RAF value during the first 10 weeks of this solution.
To learn more about how the RCxRules HCC Coding Engine can help your organization ensure accurate claims and combat the great resignation, set up a meeting today.
