The final installment in our blog post series on overcoming common HCC coding challenges tackles the issue of leadership buy-in. This multi-specialty, physician-lead medical group has over 2,000 providers nationwide and participates in MSSP.
The Challenge:
This group understood the benefits of a concurrent coder review process but needed to prove to senior management why investing in an HCC coding initiative was worthwhile.
The Approach:
They decided to create a pilot program and track the impact to share with leadership.
The Solution:
The group began by focusing their pilot program on one market that already had a coder doing concurrent HCC coding review. They worked with RCxRules to filter and prioritize the encounters that this one coder would review to narrow it down to encounters with the best opportunities for HCC capture. In most cases, these were encounters where the clinical documentation was more robust than the diagnosis codes, which enabled the coder to add or modify codes. For this group, the best opportunities were found in annual well visits for members of their ACO, followed by all other E&M codes for other value-based contracts. They tested this approach for 30 days while actively tracking the results.
The Outcome:
Within the first 30 days of the pilot, 30% of the claims the coder reviewed were able to have an HCC code added—to the tune of 127 HCC codes in total. RAF was increased by around 40 points, equating to a value of around $400k*. The organization was able to use this roughly tenfold increase in ROI to justify rolling the HCC coding process out across the entire enterprise.
Catch up on previous installments in this series: Overcoming Common HCC Coding Challenges Part 1: Limited Coder Staffing and Part 2: Understanding Payer Feedback and Turning it Into Action.
Set up a meeting to learn how RCxRules can help your organization overcome these challenges and more to improve your HCC coding accuracy and processes.
*Medical group’s share of increased RAF value is based on their payer contracts.
