Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

HCC Coding Infographic: Critical Element of Risk Management

896 views

Published on

Inaccurate HCC coding can lead to significant financial implications and variability in Risk Adjustment Factor scores. A new infographic released by PYA illustrates why coding accuracy is paramount and how implementing a best practice HCC “periodic checkup” is essential to the solution.

Published in: Healthcare
  • Diabetes Cure? You'll Be Shocked What It Is! Gov't Threatens to Shut Down Site. ★★★ https://tinyurl.com/yx3etvck
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Your GCSE maths program has had a big impact on my revision for the better. You have made everything really simple to understand while still keeping all the necessary information. This is vital to my revision as I can quickly understand the key concept of that type of question and then I can apply it to some practice questions, thus saving me time. Your other book �How To Maximise Your Result In Every GCSE Exam� has greatly helped me in all of my other subjects as I can revise effectively which frees up my time and in class tests I have noticed a significant improvement from getting B and C grades to now getting A and A* grades. Thank you very much for these guides, I wish I had found them sooner! ♣♣♣ https://bit.ly/33W8jmf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • 1 cup burns 1lb of diabetic fat every 72 hours... ▲▲▲ http://t.cn/AiBhrKDq
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Are you literally FEEDING your diabetes putting this one "health" food on your dinner plate? This is important. You must stop eating this food today or you could be doubling the speed at which your diabetes progresses... ★★★ http://scamcb.com/bloodsug/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • The Kidney Disease Solution PDF Download Link ●●● http://ishbv.com/empoweredh/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

HCC Coding Infographic: Critical Element of Risk Management

  1. 1. Seismic financial implications are associated with inaccurate HCC coding. HCC: Critical Element of Risk Management Precise HCC Coding The core of reimbursement Implement an HCC Best Practice – PYA’s HCC Checkup Since 2004, Hierarchical Condition Categories (HCC) have been a foundational element of the Centers for Medicare & Medicaid’s (CMS) capitated payments, value-based reimbursement methodology. HCC risk-adjusted framework is used through private and public plan contracts to better manage and modulate payments. ! Risk Adjustment Factors (RAFs) • Capture complex health conditions • Determine capitated payments with reimbursement rates based on 12-month retrospective patient diagnostic record • Renew HCC scores every year HCCs use RAFs to The Inevitable Drift Arising from Expedience People gradually streamline highly repetitive tasks. 78-year-old male patient presents for follow-up of labs and chronic conditions. Patient notices decreased vision in left eye lately, and will contact eye doctor today. Patient is taking medications as prescribed. Patient has follow-up in two days with specialist, will send lab results. Past Medical History: hyperlipidemia, hypertension, and type 2 diabetes Physical Exam: Normal Provider Assessment: • Chronic diastolic heart failure • Hyperlipidemia • Hypertension • Chronic kidney disease 4 • Diabetes w/renal complications and peripheral angiopathy • Diabetes w/polyneuropathy Coding needs to accurately reflect the patient conditions and those conditions must be documented in the patient’s record. Example below shows the variability when coding is not accurate. Medicare Advantage (MA) Accountable Care Organizations (ACOs) HCCPrivate Plans HMOs PPOs Our second goal is for virtually all Medicare fee-for-service payments to be tied to quality and value; at least 85% in 2016 and - Sylvia Burwell, the Secretary of HHS 90% in 2018. Unfortunately, less-than-thorough HCC patient coding is often undetected and can negatively impact clinical outcome measures and fiscal resources. *HCC 18 is ONLY counted once per patient per year Total Cost of Care & Risk Management Thorough & complete clinical documentation Accurate HCC capture & accurate diagnosis coding Subsequent year per-member- per-month reimbursement payments Health plan incentive payments Building Stability for HCC Periodic Checkup Implement a Best Practice to Ensure Thorough & Accurate Coding (865) 673-0844 | www.pyapc.com Non-Intrusive Expertise Our professional multidisciplinary team has extensive clinical backgrounds to adapt to large or small care environments and seamlessly integrate without disrupting workflow. Efficiency A modest investment delivers peace-of-mind regarding the accuracy of HCC coding and reimbursements. Objectivity PYA’s established examination processes are designed to provide neutral, unbiased assessments of HCC accuracy while aiming to help you achieve positive, sustainable outcomes. PYA’s HCC Checkup utilizes computational data analytics for retrospective chart assessments to determine the level of accuracy of HCCs captured. Access experts who provide education and training of physicians and office staff plus operational assessments including EHR analysis. Let PYA’s HCC Periodic Checkup help improve your HCC capture accuracy. TheEpicenterof the S O L U T I O N Privately Held Healthcare Consulting Firm in the U.S. as ranked by Modern Healthcare9th Largest SAMPLE Patient Record More accurate coding of actual diabetes condition has effect on RAF score. Condition ICD-10-CM Code HCC CMS Risk Score 78-year-old male 0.442 Diabetes E11.9 19 0.118 Hypertension I10 N/A 0.0 CKD Stage 4 N18.2 137 0.224 Hyperlipidemia E78.5 N/A 0.0 Diastolic heart failure I50.30 85 0.368 Total RAF Score 1.152 Total RAF Score 1.701 Coding Example 1 Coding Example 2 Condition ICD-10-CM Code HCC CMS Risk Score 78-year-old male 0.442 Type 2 diabetes w/ diabetic chronic kidney disease E11.22 18 0.368 CKD stage 4 N18.2 137 0.224 Hypertensive CKD I12.9 N/A 0.0 Type 2 diabetes w/diabetic polyneuropathy E11.42 18 0.368 Type 2 diabetes w/ diabetic peripheral angiopathy w/o gangrene E11.51 18, 108 0.368 & 0.299 Chronic diastolic heart failure I50.32 85 0.368 Hyperlipidemia E78.5 N/A 0.0

×