How Should MA Organization Approach HCC Coding?

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How Should MA Organization Approach HCC Coding?
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How Should MA Organization Approach HCC Coding?
Most of the healthcare provider that accepts
Medicare Advantage Plans (MA) are using
Hierarchical Condition Category (HCC) coding. HCC
models are designed to predict the health
spending for a specific patient population as
well as in these models the risk is equal to the
level of expected healthcare spending. Healthcare
plans and healthcare facilities utilize HCC
models. Although the models are similar in
purpose and structure, they each have unique
characteristics to address the different patient
populations for which they are utilized. The ACA
promised to offer affordable health coverage to
everyone irrespective of care visits however
there is an absence of a simple one-plan-fits-all
model for everyone to follow except Hierarchical
Condition Categories (HCC), a risk adjustment
model that has been around for years but now
gaining visibility since Medicare Advantage Plans
started to require RAF scores for
reimbursement. In this brief, you will learn to
approach HCC coding if you are a MA
organization. Training and education for
Physicians and Coding Staff You will find that
healthcare regulations are updating periodically
hence ongoing education about HCC coding
guidelines is essential for physicians and coding
staff for high-quality scores. Currently, the
world is facing a Covid-19 pandemic which puts
pressure on physicians as they already focusing
on HCC coding regulatory upkeep in addition to
the numerous responsibilities.
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How Should MA Organization Approach HCC Coding?

• Lets understand the CMS HCC model complexities
  and risk adjustment use
• CMS requires an encounter each calendar year and
  diagnosis by an APRN, PA, or physician.
• Documentation must be accurate and support the
  diagnosis.
• HCC codes are additive, and some have
  multipliers.
• HCC codes are not always intuitive. Physicians
  may require decision support.
• Population complexity/severity affects payment in
  many Medicare contracts.
• RAF is used for benchmarking for quality and
  safety.
• RAF enables identification and stratification for
  patient management.
• Now, you have a better outlook of HCC model
  complexities and the need for training and
  education. However, you can do the followings
  things to optimize training and education efforts
• Identify and engage physicians who can champion
  the importance of HCC coding among their peers.
• Identify the most used and frequently occurring
  HCC codes in your organization and have
  physicians focus on them instead of all the 86
  HCC categories.

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How Should MA Organization Approach HCC Coding?

• MEAT is the heart of HCC coding
• M.E.A.T. stands for M-monitoring, E-evaluating,
  A-assessing, and T-treatment which is the heart
  of HCC coding and clinical documentation and is
  defined as follows
• Monitor signs, symptoms, disease progression,
  disease regression
• Evaluate-test results, medication effectiveness,
  response to treatment
• Assess/Address-ordering tests, discussion, review
  records, counseling
• Treat-medications, therapies, other modalities
• Healthcare providers need awareness about the
  essentials that should be present in the medical
  record to stay compliant and mitigate the risk of
  audits. Proper documentation is key to capture
  the most accurate HCC code for the diagnosis.
  Hence documentation should indicate the diagnosis
  is MEAT i.e., Being monitored, evaluated,
  assessed/addressed, or treated (M.E.A.T.).
• You should properly report secondary diagnosis
• The main reason behind the loss of reimbursement
  is not reporting secondary diagnoses of patients
  properly. There is a chance that you will miss
  the opportunity for optimal reimbursement while
  pulling information from multiple data sources
  (hospital inpatient, hospital outpatient/
  physician).

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How Should MA Organization Approach HCC Coding?
When it comes to outpatients encounters
secondary and/or chronic conditions are often not
reported due to data interoperability, which
should be considered while reviewing the root
cause of low-risk factor scores Outsource your
HCC coding If you are not confident about
converting medical documentation into HCC coding,
then you should consider outsourcing certified
risk adjustment coders who deliver consistent and
compliant HCC coding performance to reap the
benefits of optimal reimbursements. Moreover, you
dont need to have specialized coding expertise
and proficient experience with knowing where to
search deeper for coding acuity. You can
consider MedisysData while outsourcing your HCC
coding as we reduce your administrative burden as
well as you can focus on your core competency
i.e., delivering better patient care. We are a
team of HIPAA compliant coders who are
specialized in coding services including HCC code
assignment. You can feel rest assured about CMS
Audit samples before submission deadlines to
obtain optimal reimbursement once you avail of
our services.
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