SlideShare a Scribd company logo
Five Action Items to
Improve HCC Coding
Accuracy and Risk
Adjustment With Analytics
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
As enrollment in Medicare Advantage plans increases,
healthcare organizations need to be able to anticipate
future healthcare financial resources and predict
appropriate reimbursement for physicians.
Coding Accuracy and Risk Adjustment
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The Hierarchical Condition Category (HCC)
risk adjustment model is used by CMS to
estimate predicted costs for Medicare
Advantage beneficiaries, and the results
directly impact the reimbursement healthcare
organizations receive.
The HCC risk adjustment model was
originally implemented in 2004, but is
becoming more prevalent as value-based
payment models gain popularity.
Coding Accuracy and Risk Adjustment
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The HCC model assigns a Risk Adjustment
Factor (RAF) to each Medicare patient as
measurement of probable costs, which is then
used to adjust capitation payments for patients
enrolled in Medicare Advantage plans.
Accurate HCC coding and risk adjustment
can have a significant impact on healthcare
organizations’ financial viability and care
delivery.
Coding Accuracy and Risk Adjustment
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
CMS requires that all qualifying conditions be
identified each year by provider organizations.
Documentation linked to a non-specific
diagnosis, as well as incomplete
documentation, negatively affects
reimbursement.
Healthcare organizations that optimize
their EMR, data, analytics, and education
can enable better documentation of
care for patients with chronic diseases,
leading to more accurate HCC risk
adjustment coding.
HCC Model Complexities and
Risk Adjustment Use
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The number of Medicare Advantage beneficiaries
has continued to rise over the past ten years, with
roughly one-in-three Medicare beneficiaries now
enrolled in a Medicare Advantage plan.
As with starting any new initiative, HCC
coding is not intuitive, but accurate
HCC coding is necessary for healthcare
organizations in order to receive fair
compensation.
HCC Model Complexities and
Risk Adjustment Use
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
There are a few highlights to know about 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.
Some codes have RAF value. Some do not. Increased severity doesn’t usually
increase risk adjustment factor (RAF).
HCC codes are not always intuitive. Physicians may require decision support.
HCC codes are additive, and some have multipliers.
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.
HCC Model Complexities and
Risk Adjustment Use
>
>
>
>
>
>
>
>
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Even though the payment model is not intuitive,
an organization’s ability to perform well within
this model should increase over time.
For example, in Figure 1, the table shows
sample patient data from a 76-year-old
female patient with an RAF score of .448.
The two options show how different
diagnoses change the patient’s risk
score, and, as a result, the annual
member payment.
The Impact of Appropriate HCC Coding
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The Impact of Appropriate HCC Coding
Impact of Appropriate HCC Coding on Payment
Female, age 76, Not: originally disabled, Medicaid, ERSD, or
institutionalized, Demographic RAF score = .488
Option 1 HCC Risk Score
Obesity 0
Type 2 diabetes, exudative retinopathy .104, 0
Major depression disorder,
Single episode, unspecified
0
CHF .323
Asthma 0
Pressure ulcer of right heel, unspecified 0
CHF*DM .154
RAF score: 1.029
Sample MedicareAdvantage member payment,Annual: $9K
Option 2 HCC Risk Score
Morbid obesity, BMI 42 .273
Type 2 diabetes, w/diabetic retinopathy .318
Major depression disorder,
Single episode, mild
.395
CHF, class 3 .323
COPD .328
Pressure ulcer of right heel, stage 3 1.204
CHF*DM; CHF*COPD .154, .19
RAF score: 3.633
Sample MedicareAdvantage member payment,Annual: $32K
Figure 1: The impact of appropriate HCC Coding on payment
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The two different options show a patient of similar
complexity but varying diagnoses, which results
in vastly different annual member payments.
Option one showed a total RAF score 1.029 and
an annual Medical Advantage member payment
of $9,000.
Option two showed a RAF score of 3.633 and a
Medicare Advantage member payment of
$32,000 annually.
While physicians should not change their
diagnoses, it is important to code accurately
and take credit, where deserved, for serving
a complex population.
The Impact of Appropriate HCC Coding
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
The example provides a compelling rationale
for organizations to improve their HCC coding
accuracy.
However, the first step is obtaining accurate
data about Medicare populations before trying
to make improvements in this space.
It may also be beneficial to form a workgroup
that is responsible for improving the accuracy
of documentation and HCC coding.
Driving Improvement Through
Interdisciplinary Workgroups
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
This workgroup could include members of:
• The analytics team
• Accountable Care Organization (ACO) team
• Clinicians
• Clinic managers
• Operations
• Medical coders.
Driving Improvement Through
Interdisciplinary Workgroups
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Forming the workgroup can help oversee these five
key action items necessary for improving HCC
coding accuracy:
1. Having an accurate problem list
2. Ensuring patients are seen in each calendar year
3. Improving decision support and EMR optimization
4. Widespread education and communication
5. Tracking performance and identifying opportunities
Driving Improvement Through
Interdisciplinary Workgroups
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
1: Having an accurate problem list
Many healthcare organizations have been
inputting data in an EMR for years now,
resulting in lots of data, and most likely an
inaccurate problem list.
Ensuring an accurate problem list involves
removing duplicative and inactive diagnoses,
identifying key areas with discrete data in the
EMR, and using a diagnosis preference list to
include HCC suffix codes and RAF values as
well as prioritize results.
Driving Improvement Through
Interdisciplinary Workgroups
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
2: Ensuring patients are seen in each calendar year
Driving Improvement Through
Interdisciplinary Workgroups
The first step is to identify patients with chronic
illnesses who have not been seen during the
calendar year and once found, schedule that
patient for a visit.
One way to do this at a glance is to build a
clinical dashboard that provides a snapshot
of both EMR and claims data that provides a
complete picture of patients not yet seen in
a calendar year.
Once the workgroup can identify these
patients, they can match them with both
visit and HCC coding gaps.
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
3: Improving decision support and EMR optimization
Driving Improvement Through
Interdisciplinary Workgroups
Although educating providers is necessary to
improve HCC coding accuracy, it’s also
important to build appropriate coding into the
daily encounter workflow.
Some potential strategies include having an
ACO identifier flagged in the EMR, decision-
support tools that can be activated for select
populations, and HCC diagnosis alerts for
past codes.
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
4: Widespread education and communication
Driving Improvement Through
Interdisciplinary Workgroups
Because this is new work and certainly not
intuitive, it’s important to educate clinicians.
The biggest educational point to drive home to
clinicians is not what score they should look for,
but the importance of accuracy.
Workgroups can educate clinicians on the
clinical and financial value of specificity.
They can also educate clinic staff about
the specifics of the tools and workflows
for patient management and reporting.
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5: Tracking performance and identifying opportunities
Driving Improvement Through
Interdisciplinary Workgroups
The last, and perhaps most important key
initiative of the workgroup is to track
performance and identify future opportunities
for improvement.
Measuring results provides the workgroup with
compelling data to bring to stakeholders that
shows what improvements were made, such
as an increase in average RAF score,
improvement in key problem list diagnoses,
decrease in the number of members without
an annual visit, an increase in the percentage
of persistent condition diagnoses resolved.
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
5: Tracking performance and identifying opportunities
Driving Improvement Through
Interdisciplinary Workgroups
Once the workgroup has data to bring to
stakeholders, the next step is to identify future
opportunities for further improvements.
One place to look for these is by reviewing
unresolved persistent conditions for specific
populations.
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Key Lessons
For organizations that are looking to embark on
an effort to improve their HCC coding accuracy
and risk adjustment, below are four valuable
lessons learned:
The magnitude and presence of coding accuracy
opportunities are not evident without data.
Using data to focus efforts helped find topics that
were practice and valuable to end users and
improve engagement.
It is manageable and effective to use the EMR
upstream and during encounters.
Clinic staff want reports to see how they are
doing compared to peers.
>
>
>
>
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Fair Reimbursement for Serving
Complex Patient Populations
Although HCC coding accuracy and risk adjustment
requires changes to the way healthcare organizations
are documenting and coding chronic conditions,
doing so can help the organization capture more
complete diagnoses, resulting in higher and more
appropriate reimbursement and improved care
delivery for complex patient populations.
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Fair Reimbursement for Serving
Complex Patient Populations
With increasing Medicare Advantage numbers,
healthcare organizations need to improve
coding accuracy to remain financially viable.
Creating a workgroup that’s responsible for
key action items is crucial to the success
of this initiative.
They can help ensure the organization has an
accurate problem list, chronically ill patients
are seen once per calendar year, improve
decision-support and EMR optimization,
educate clinicians and staff, and track
performance of the initiatives to share
with stakeholders.
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Fair Reimbursement for Serving
Complex Patient Populations
If healthcare organizations appropriately
document the complexity of their patients,
they are eligible for greater CMS revenue
that can then be reinvested to better meet
the needs of their patient population.
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
More about this topic
Link to original article for a more in-depth discussion.
Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics
ACOs: Four Ways Technology Contributes to Success
Health Catalyst Editors
Understanding Risk Stratification, Comorbidities, and the Future of Healthcare
Eric Just, SVP of Product Development
Healthcare Data Management: Three Principles of Using Data to Its Full Potential
Sean Whitaker
Why Clinical Quality Should Drive Healthcare Business Strategy
Health Catalyst Editors
Linking Clinical and Financial Data: The Key to Real Quality and Cost Outcomes
Bobbi Brown, MBA, SVP
© 2019 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company
that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes
needed to improve population health and accountable care. Our proven enterprise data warehouse
(EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more
than 65 million patients for organizations ranging from the largest US health system to forward-thinking
physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”

More Related Content

What's hot

Physician assistant power point
Physician assistant power pointPhysician assistant power point
Physician assistant power point
Ainsley Wingard
 
Reflections on Medical Humanities
Reflections on Medical Humanities Reflections on Medical Humanities
Reflections on Medical Humanities
Anjali Malpani
 
placement orientation program for anm & gnm final yearstudents.pptx
placement orientation program for anm & gnm final yearstudents.pptxplacement orientation program for anm & gnm final yearstudents.pptx
placement orientation program for anm & gnm final yearstudents.pptx
Kanchan Devi
 
Health care system in india
Health care system in indiaHealth care system in india
Health care system in india
smybhargava123
 
Death & the doctor
Death & the doctorDeath & the doctor
Death & the doctor
biju tharayil
 
Concept of Elderly
Concept of ElderlyConcept of Elderly
Concept of Elderly
Sankappa Gulaganji
 
Primary care-provider-infographic
Primary care-provider-infographicPrimary care-provider-infographic
Primary care-provider-infographic
Doylestown Health
 
A nurse can do that
A nurse can do thatA nurse can do that
A nurse can do that
Lisa Hezel RN ACHRN WCC OMS
 
American Indian and Alaska Native (AI/AN)
American Indian and Alaska Native (AI/AN)American Indian and Alaska Native (AI/AN)
American Indian and Alaska Native (AI/AN)
Reyna Payamps
 
Understanding transference
Understanding transferenceUnderstanding transference
Understanding transference
Alan MacKenzie
 

What's hot (10)

Physician assistant power point
Physician assistant power pointPhysician assistant power point
Physician assistant power point
 
Reflections on Medical Humanities
Reflections on Medical Humanities Reflections on Medical Humanities
Reflections on Medical Humanities
 
placement orientation program for anm & gnm final yearstudents.pptx
placement orientation program for anm & gnm final yearstudents.pptxplacement orientation program for anm & gnm final yearstudents.pptx
placement orientation program for anm & gnm final yearstudents.pptx
 
Health care system in india
Health care system in indiaHealth care system in india
Health care system in india
 
Death & the doctor
Death & the doctorDeath & the doctor
Death & the doctor
 
Concept of Elderly
Concept of ElderlyConcept of Elderly
Concept of Elderly
 
Primary care-provider-infographic
Primary care-provider-infographicPrimary care-provider-infographic
Primary care-provider-infographic
 
A nurse can do that
A nurse can do thatA nurse can do that
A nurse can do that
 
American Indian and Alaska Native (AI/AN)
American Indian and Alaska Native (AI/AN)American Indian and Alaska Native (AI/AN)
American Indian and Alaska Native (AI/AN)
 
Understanding transference
Understanding transferenceUnderstanding transference
Understanding transference
 

Similar to Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics

HCC coding and risk adjustment.pdf
HCC coding and risk adjustment.pdfHCC coding and risk adjustment.pdf
HCC coding and risk adjustment.pdf
Inferscience
 
ACOs: Four Ways Technology Contributes to Success
ACOs: Four Ways Technology Contributes to SuccessACOs: Four Ways Technology Contributes to Success
ACOs: Four Ways Technology Contributes to Success
Health Catalyst
 
The Changing Role of the Provider in HCC Coding
The Changing Role of the Provider in HCC CodingThe Changing Role of the Provider in HCC Coding
The Changing Role of the Provider in HCC Coding
Inferscience
 
What is HCC Coding and Why Is It Important?
What is HCC Coding and Why Is It Important?What is HCC Coding and Why Is It Important?
What is HCC Coding and Why Is It Important?
Meditab
 
Healthcare Quality Coalition letter
Healthcare Quality Coalition letterHealthcare Quality Coalition letter
Healthcare Quality Coalition letter
Post-Bulletin Co.
 
industry-in-focus
industry-in-focusindustry-in-focus
industry-in-focus
Nathan Louque
 
Impact on Health Reform on Device Development and Funding
Impact on Health Reform on Device Development and FundingImpact on Health Reform on Device Development and Funding
Impact on Health Reform on Device Development and Funding
UBMCanon
 
150228 Should ACO's Attract the Sick v1.8
150228 Should ACO's Attract  the Sick v1.8150228 Should ACO's Attract  the Sick v1.8
150228 Should ACO's Attract the Sick v1.8
Orry Jacobs
 
The 100-Percent Solution to Improving Healthcare’s Operating Margins
The 100-Percent Solution to Improving Healthcare’s Operating MarginsThe 100-Percent Solution to Improving Healthcare’s Operating Margins
The 100-Percent Solution to Improving Healthcare’s Operating Margins
Health Catalyst
 
How Physicians Can Prepare for the Financial Impact of MACRA
How Physicians Can Prepare for the Financial Impact of MACRAHow Physicians Can Prepare for the Financial Impact of MACRA
How Physicians Can Prepare for the Financial Impact of MACRA
Health Catalyst
 
Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...
Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...
Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...
Health Catalyst
 
Risk Adjustment
Risk AdjustmentRisk Adjustment
Risk Adjustment
rafscorecalculator
 
Value-Based Healthcare Strategies
Value-Based Healthcare StrategiesValue-Based Healthcare Strategies
Value-Based Healthcare Strategies
Colin Bertram
 
Mastering the Art of Medical Billing: A Comprehensive Guide to Success
Mastering the Art of Medical Billing: A Comprehensive Guide to SuccessMastering the Art of Medical Billing: A Comprehensive Guide to Success
Mastering the Art of Medical Billing: A Comprehensive Guide to Success
jwilliamj223
 
From Fee-for-Service to Fee-for-Value
From Fee-for-Service to Fee-for-ValueFrom Fee-for-Service to Fee-for-Value
From Fee-for-Service to Fee-for-Value
Strategy&, a member of the PwC network
 
Accountable Care Organization (ACO) Tutorial
Accountable Care Organization (ACO) TutorialAccountable Care Organization (ACO) Tutorial
Accountable Care Organization (ACO) Tutorial
Charles DeShazer, M.D.
 
Clinical Integration
Clinical IntegrationClinical Integration
Clinical Integration
PatWilson13
 
Navigating Challenges in HCC Coding and Risk Adjustment
Navigating Challenges in HCC Coding and Risk AdjustmentNavigating Challenges in HCC Coding and Risk Adjustment
Navigating Challenges in HCC Coding and Risk Adjustment
Inferscience
 
HCC Coding Technology in the New Year
HCC Coding Technology in the New YearHCC Coding Technology in the New Year
HCC Coding Technology in the New Year
Inferscience
 
PAYMENT MODELS
PAYMENT MODELSPAYMENT MODELS
PAYMENT MODELS
Tony Fanelli
 

Similar to Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics (20)

HCC coding and risk adjustment.pdf
HCC coding and risk adjustment.pdfHCC coding and risk adjustment.pdf
HCC coding and risk adjustment.pdf
 
ACOs: Four Ways Technology Contributes to Success
ACOs: Four Ways Technology Contributes to SuccessACOs: Four Ways Technology Contributes to Success
ACOs: Four Ways Technology Contributes to Success
 
The Changing Role of the Provider in HCC Coding
The Changing Role of the Provider in HCC CodingThe Changing Role of the Provider in HCC Coding
The Changing Role of the Provider in HCC Coding
 
What is HCC Coding and Why Is It Important?
What is HCC Coding and Why Is It Important?What is HCC Coding and Why Is It Important?
What is HCC Coding and Why Is It Important?
 
Healthcare Quality Coalition letter
Healthcare Quality Coalition letterHealthcare Quality Coalition letter
Healthcare Quality Coalition letter
 
industry-in-focus
industry-in-focusindustry-in-focus
industry-in-focus
 
Impact on Health Reform on Device Development and Funding
Impact on Health Reform on Device Development and FundingImpact on Health Reform on Device Development and Funding
Impact on Health Reform on Device Development and Funding
 
150228 Should ACO's Attract the Sick v1.8
150228 Should ACO's Attract  the Sick v1.8150228 Should ACO's Attract  the Sick v1.8
150228 Should ACO's Attract the Sick v1.8
 
The 100-Percent Solution to Improving Healthcare’s Operating Margins
The 100-Percent Solution to Improving Healthcare’s Operating MarginsThe 100-Percent Solution to Improving Healthcare’s Operating Margins
The 100-Percent Solution to Improving Healthcare’s Operating Margins
 
How Physicians Can Prepare for the Financial Impact of MACRA
How Physicians Can Prepare for the Financial Impact of MACRAHow Physicians Can Prepare for the Financial Impact of MACRA
How Physicians Can Prepare for the Financial Impact of MACRA
 
Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...
Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...
Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritiz...
 
Risk Adjustment
Risk AdjustmentRisk Adjustment
Risk Adjustment
 
Value-Based Healthcare Strategies
Value-Based Healthcare StrategiesValue-Based Healthcare Strategies
Value-Based Healthcare Strategies
 
Mastering the Art of Medical Billing: A Comprehensive Guide to Success
Mastering the Art of Medical Billing: A Comprehensive Guide to SuccessMastering the Art of Medical Billing: A Comprehensive Guide to Success
Mastering the Art of Medical Billing: A Comprehensive Guide to Success
 
From Fee-for-Service to Fee-for-Value
From Fee-for-Service to Fee-for-ValueFrom Fee-for-Service to Fee-for-Value
From Fee-for-Service to Fee-for-Value
 
Accountable Care Organization (ACO) Tutorial
Accountable Care Organization (ACO) TutorialAccountable Care Organization (ACO) Tutorial
Accountable Care Organization (ACO) Tutorial
 
Clinical Integration
Clinical IntegrationClinical Integration
Clinical Integration
 
Navigating Challenges in HCC Coding and Risk Adjustment
Navigating Challenges in HCC Coding and Risk AdjustmentNavigating Challenges in HCC Coding and Risk Adjustment
Navigating Challenges in HCC Coding and Risk Adjustment
 
HCC Coding Technology in the New Year
HCC Coding Technology in the New YearHCC Coding Technology in the New Year
HCC Coding Technology in the New Year
 
PAYMENT MODELS
PAYMENT MODELSPAYMENT MODELS
PAYMENT MODELS
 

More from Health Catalyst

Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondEmpowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Health Catalyst
 
Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...
Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...
Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...
Health Catalyst
 
Looking Ahead: Market Trends Impacting Key Healthcare Issues
Looking Ahead: Market Trends Impacting Key Healthcare IssuesLooking Ahead: Market Trends Impacting Key Healthcare Issues
Looking Ahead: Market Trends Impacting Key Healthcare Issues
Health Catalyst
 
2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights
Health Catalyst
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and Labor
Health Catalyst
 
2024 CPT® Updates (Professional Services Focused) - Part 3
2024 CPT® Updates (Professional Services Focused) - Part 32024 CPT® Updates (Professional Services Focused) - Part 3
2024 CPT® Updates (Professional Services Focused) - Part 3
Health Catalyst
 
2024 CPT® Code Updates (HIM Focused) - Part 2
2024 CPT® Code Updates (HIM Focused) - Part 22024 CPT® Code Updates (HIM Focused) - Part 2
2024 CPT® Code Updates (HIM Focused) - Part 2
Health Catalyst
 
2024 CPT® Code Updates (CDM Focused) - Part 1
2024 CPT® Code Updates (CDM Focused) - Part 12024 CPT® Code Updates (CDM Focused) - Part 1
2024 CPT® Code Updates (CDM Focused) - Part 1
Health Catalyst
 
What’s Next for Hospital Price Transparency in 2024 and Beyond
What’s Next for Hospital Price Transparency in 2024 and BeyondWhat’s Next for Hospital Price Transparency in 2024 and Beyond
What’s Next for Hospital Price Transparency in 2024 and Beyond
Health Catalyst
 
Automated Patient Reported Outcomes (PROs) for Hip & Knee Replacement
Automated Patient Reported Outcomes (PROs) for Hip & Knee ReplacementAutomated Patient Reported Outcomes (PROs) for Hip & Knee Replacement
Automated Patient Reported Outcomes (PROs) for Hip & Knee Replacement
Health Catalyst
 
2024 Medicare Physician Fee Schedule (MPFS) Final Rule Updates
2024 Medicare Physician Fee Schedule (MPFS) Final Rule Updates2024 Medicare Physician Fee Schedule (MPFS) Final Rule Updates
2024 Medicare Physician Fee Schedule (MPFS) Final Rule Updates
Health Catalyst
 
What's Next for OPPS: A Look at the 2024 Final Rule
What's Next for OPPS: A Look at the 2024 Final RuleWhat's Next for OPPS: A Look at the 2024 Final Rule
What's Next for OPPS: A Look at the 2024 Final Rule
Health Catalyst
 
Insight into the 2024 ICD-10 PCS Updates - Part 2
Insight into the 2024 ICD-10 PCS Updates - Part 2Insight into the 2024 ICD-10 PCS Updates - Part 2
Insight into the 2024 ICD-10 PCS Updates - Part 2
Health Catalyst
 
Vitalware Insight Into the 2024 ICD10 CM Updates.pdf
Vitalware Insight Into the 2024 ICD10 CM Updates.pdfVitalware Insight Into the 2024 ICD10 CM Updates.pdf
Vitalware Insight Into the 2024 ICD10 CM Updates.pdf
Health Catalyst
 
Driving Value: Boosting Clinical Registry Value Using ARMUS Solutions
Driving Value: Boosting Clinical Registry Value Using ARMUS SolutionsDriving Value: Boosting Clinical Registry Value Using ARMUS Solutions
Driving Value: Boosting Clinical Registry Value Using ARMUS Solutions
Health Catalyst
 
Tech-Enabled Managed Services: Not Your Average Outsourcing
Tech-Enabled Managed Services: Not Your Average OutsourcingTech-Enabled Managed Services: Not Your Average Outsourcing
Tech-Enabled Managed Services: Not Your Average Outsourcing
Health Catalyst
 
2023 Mid-Year CPT/HCPCS Code Set Updates
2023 Mid-Year CPT/HCPCS Code Set Updates2023 Mid-Year CPT/HCPCS Code Set Updates
2023 Mid-Year CPT/HCPCS Code Set Updates
Health Catalyst
 
How Managing Chronic Conditions Is Streamlined with Digital Technology
How Managing Chronic Conditions Is Streamlined with Digital TechnologyHow Managing Chronic Conditions Is Streamlined with Digital Technology
How Managing Chronic Conditions Is Streamlined with Digital Technology
Health Catalyst
 
COVID-19: After the Public Health Emergency Ends
COVID-19: After the Public Health Emergency EndsCOVID-19: After the Public Health Emergency Ends
COVID-19: After the Public Health Emergency Ends
Health Catalyst
 
Automated Medication Compliance Tools for the Provider and Patient
Automated Medication Compliance Tools for the Provider and PatientAutomated Medication Compliance Tools for the Provider and Patient
Automated Medication Compliance Tools for the Provider and Patient
Health Catalyst
 

More from Health Catalyst (20)

Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondEmpowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
 
Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...
Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...
Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...
 
Looking Ahead: Market Trends Impacting Key Healthcare Issues
Looking Ahead: Market Trends Impacting Key Healthcare IssuesLooking Ahead: Market Trends Impacting Key Healthcare Issues
Looking Ahead: Market Trends Impacting Key Healthcare Issues
 
2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and Labor
 
2024 CPT® Updates (Professional Services Focused) - Part 3
2024 CPT® Updates (Professional Services Focused) - Part 32024 CPT® Updates (Professional Services Focused) - Part 3
2024 CPT® Updates (Professional Services Focused) - Part 3
 
2024 CPT® Code Updates (HIM Focused) - Part 2
2024 CPT® Code Updates (HIM Focused) - Part 22024 CPT® Code Updates (HIM Focused) - Part 2
2024 CPT® Code Updates (HIM Focused) - Part 2
 
2024 CPT® Code Updates (CDM Focused) - Part 1
2024 CPT® Code Updates (CDM Focused) - Part 12024 CPT® Code Updates (CDM Focused) - Part 1
2024 CPT® Code Updates (CDM Focused) - Part 1
 
What’s Next for Hospital Price Transparency in 2024 and Beyond
What’s Next for Hospital Price Transparency in 2024 and BeyondWhat’s Next for Hospital Price Transparency in 2024 and Beyond
What’s Next for Hospital Price Transparency in 2024 and Beyond
 
Automated Patient Reported Outcomes (PROs) for Hip & Knee Replacement
Automated Patient Reported Outcomes (PROs) for Hip & Knee ReplacementAutomated Patient Reported Outcomes (PROs) for Hip & Knee Replacement
Automated Patient Reported Outcomes (PROs) for Hip & Knee Replacement
 
2024 Medicare Physician Fee Schedule (MPFS) Final Rule Updates
2024 Medicare Physician Fee Schedule (MPFS) Final Rule Updates2024 Medicare Physician Fee Schedule (MPFS) Final Rule Updates
2024 Medicare Physician Fee Schedule (MPFS) Final Rule Updates
 
What's Next for OPPS: A Look at the 2024 Final Rule
What's Next for OPPS: A Look at the 2024 Final RuleWhat's Next for OPPS: A Look at the 2024 Final Rule
What's Next for OPPS: A Look at the 2024 Final Rule
 
Insight into the 2024 ICD-10 PCS Updates - Part 2
Insight into the 2024 ICD-10 PCS Updates - Part 2Insight into the 2024 ICD-10 PCS Updates - Part 2
Insight into the 2024 ICD-10 PCS Updates - Part 2
 
Vitalware Insight Into the 2024 ICD10 CM Updates.pdf
Vitalware Insight Into the 2024 ICD10 CM Updates.pdfVitalware Insight Into the 2024 ICD10 CM Updates.pdf
Vitalware Insight Into the 2024 ICD10 CM Updates.pdf
 
Driving Value: Boosting Clinical Registry Value Using ARMUS Solutions
Driving Value: Boosting Clinical Registry Value Using ARMUS SolutionsDriving Value: Boosting Clinical Registry Value Using ARMUS Solutions
Driving Value: Boosting Clinical Registry Value Using ARMUS Solutions
 
Tech-Enabled Managed Services: Not Your Average Outsourcing
Tech-Enabled Managed Services: Not Your Average OutsourcingTech-Enabled Managed Services: Not Your Average Outsourcing
Tech-Enabled Managed Services: Not Your Average Outsourcing
 
2023 Mid-Year CPT/HCPCS Code Set Updates
2023 Mid-Year CPT/HCPCS Code Set Updates2023 Mid-Year CPT/HCPCS Code Set Updates
2023 Mid-Year CPT/HCPCS Code Set Updates
 
How Managing Chronic Conditions Is Streamlined with Digital Technology
How Managing Chronic Conditions Is Streamlined with Digital TechnologyHow Managing Chronic Conditions Is Streamlined with Digital Technology
How Managing Chronic Conditions Is Streamlined with Digital Technology
 
COVID-19: After the Public Health Emergency Ends
COVID-19: After the Public Health Emergency EndsCOVID-19: After the Public Health Emergency Ends
COVID-19: After the Public Health Emergency Ends
 
Automated Medication Compliance Tools for the Provider and Patient
Automated Medication Compliance Tools for the Provider and PatientAutomated Medication Compliance Tools for the Provider and Patient
Automated Medication Compliance Tools for the Provider and Patient
 

Recently uploaded

disease condition seen in adolescent girl " ANEMIA"
disease condition seen in adolescent girl " ANEMIA"disease condition seen in adolescent girl " ANEMIA"
disease condition seen in adolescent girl " ANEMIA"
purvipatel517209
 
Shampoo - cosmetics B.pharm mpharam.pptx
Shampoo - cosmetics B.pharm mpharam.pptxShampoo - cosmetics B.pharm mpharam.pptx
Shampoo - cosmetics B.pharm mpharam.pptx
G.M.R ACADEMY G.M.R
 
Teaching Methodology of Hatha Yoga Teacher Training Course.pptx
Teaching Methodology of Hatha Yoga Teacher Training Course.pptxTeaching Methodology of Hatha Yoga Teacher Training Course.pptx
Teaching Methodology of Hatha Yoga Teacher Training Course.pptx
Karuna Yoga Vidya Peetham
 
WHO PPCs for therapeutic HPV vaccines_June2024.pdf
WHO PPCs for therapeutic HPV vaccines_June2024.pdfWHO PPCs for therapeutic HPV vaccines_June2024.pdf
WHO PPCs for therapeutic HPV vaccines_June2024.pdf
anabakhtar
 
Girls Call Hyderabad 000XX00000 Provide Best And Top Girl Service And No1 in ...
Girls Call Hyderabad 000XX00000 Provide Best And Top Girl Service And No1 in ...Girls Call Hyderabad 000XX00000 Provide Best And Top Girl Service And No1 in ...
Girls Call Hyderabad 000XX00000 Provide Best And Top Girl Service And No1 in ...
pinkichadda23 #v08
 
buy oxycodone online at chemworldstore.net
buy oxycodone online at chemworldstore.netbuy oxycodone online at chemworldstore.net
buy oxycodone online at chemworldstore.net
luciatcupups
 
Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...
Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...
Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...
Levi Shapiro
 
Yoga for Beginner’s Course- yoga foundation course
Yoga for Beginner’s Course- yoga foundation courseYoga for Beginner’s Course- yoga foundation course
Yoga for Beginner’s Course- yoga foundation course
Karuna Yoga Vidya Peetham
 
Yoga, Anatomy & Physiology Certificate Course.pptxv.pptx
Yoga, Anatomy & Physiology Certificate Course.pptxv.pptxYoga, Anatomy & Physiology Certificate Course.pptxv.pptx
Yoga, Anatomy & Physiology Certificate Course.pptxv.pptx
Karuna Yoga Vidya Peetham
 
Apcalis Sx 20 Mg Oral Jelly July 2024.pdf
Apcalis Sx 20 Mg Oral Jelly July 2024.pdfApcalis Sx 20 Mg Oral Jelly July 2024.pdf
Apcalis Sx 20 Mg Oral Jelly July 2024.pdf
cenforceonlinestoreu
 
OT Dude's Salary Survey Report July 2024.pdf
OT Dude's Salary Survey Report July 2024.pdfOT Dude's Salary Survey Report July 2024.pdf
OT Dude's Salary Survey Report July 2024.pdf
OTDUDE
 
Cyberattacks on Healthcare Systemss.pptx
Cyberattacks on Healthcare Systemss.pptxCyberattacks on Healthcare Systemss.pptx
Cyberattacks on Healthcare Systemss.pptx
JoeOrlando16
 
TheHistroke 340B Product Presentation_MetaBridge
TheHistroke 340B Product Presentation_MetaBridgeTheHistroke 340B Product Presentation_MetaBridge
TheHistroke 340B Product Presentation_MetaBridge
TheHistroke
 
Abortion pills for sale in Qatar(+919707208804)Buy Cytotec tablet in Doha
Abortion pills for sale in Qatar(+919707208804)Buy Cytotec tablet in DohaAbortion pills for sale in Qatar(+919707208804)Buy Cytotec tablet in Doha
Abortion pills for sale in Qatar(+919707208804)Buy Cytotec tablet in Doha
maishakhanam230
 
Top Rated Massage Center In Ajman | Massage Center Deals Sharjah
Top Rated Massage Center In Ajman | Massage Center Deals SharjahTop Rated Massage Center In Ajman | Massage Center Deals Sharjah
Top Rated Massage Center In Ajman | Massage Center Deals Sharjah
Jameela Massage and Relaxation Centre Ajman
 
Yoga Nidra Teacher Training Certification Course
Yoga Nidra Teacher Training Certification CourseYoga Nidra Teacher Training Certification Course
Yoga Nidra Teacher Training Certification Course
Karuna Yoga Vidya Peetham
 
Automated Feedback in Digital Depression Screening: DISCOVER Trial | The Life...
Automated Feedback in Digital Depression Screening: DISCOVER Trial | The Life...Automated Feedback in Digital Depression Screening: DISCOVER Trial | The Life...
Automated Feedback in Digital Depression Screening: DISCOVER Trial | The Life...
The Lifesciences Magazine
 
Multiple Sclerosis and the Immune System - Plexus
Multiple Sclerosis and the Immune System - PlexusMultiple Sclerosis and the Immune System - Plexus
Multiple Sclerosis and the Immune System - Plexus
Albert840788
 
Extraction Vs non exraction in orthodontics.pptx
Extraction Vs  non exraction in orthodontics.pptxExtraction Vs  non exraction in orthodontics.pptx
Extraction Vs non exraction in orthodontics.pptx
Anagha Prasad
 
Vasundhara Fertility (IVF) Centre Jodhpur
Vasundhara Fertility (IVF) Centre JodhpurVasundhara Fertility (IVF) Centre Jodhpur
Vasundhara Fertility (IVF) Centre Jodhpur
VasundharaIVF
 

Recently uploaded (20)

disease condition seen in adolescent girl " ANEMIA"
disease condition seen in adolescent girl " ANEMIA"disease condition seen in adolescent girl " ANEMIA"
disease condition seen in adolescent girl " ANEMIA"
 
Shampoo - cosmetics B.pharm mpharam.pptx
Shampoo - cosmetics B.pharm mpharam.pptxShampoo - cosmetics B.pharm mpharam.pptx
Shampoo - cosmetics B.pharm mpharam.pptx
 
Teaching Methodology of Hatha Yoga Teacher Training Course.pptx
Teaching Methodology of Hatha Yoga Teacher Training Course.pptxTeaching Methodology of Hatha Yoga Teacher Training Course.pptx
Teaching Methodology of Hatha Yoga Teacher Training Course.pptx
 
WHO PPCs for therapeutic HPV vaccines_June2024.pdf
WHO PPCs for therapeutic HPV vaccines_June2024.pdfWHO PPCs for therapeutic HPV vaccines_June2024.pdf
WHO PPCs for therapeutic HPV vaccines_June2024.pdf
 
Girls Call Hyderabad 000XX00000 Provide Best And Top Girl Service And No1 in ...
Girls Call Hyderabad 000XX00000 Provide Best And Top Girl Service And No1 in ...Girls Call Hyderabad 000XX00000 Provide Best And Top Girl Service And No1 in ...
Girls Call Hyderabad 000XX00000 Provide Best And Top Girl Service And No1 in ...
 
buy oxycodone online at chemworldstore.net
buy oxycodone online at chemworldstore.netbuy oxycodone online at chemworldstore.net
buy oxycodone online at chemworldstore.net
 
Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...
Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...
Reimbursement Bootcamp- Coding, Coverage & Payment lecture by David Farber, K...
 
Yoga for Beginner’s Course- yoga foundation course
Yoga for Beginner’s Course- yoga foundation courseYoga for Beginner’s Course- yoga foundation course
Yoga for Beginner’s Course- yoga foundation course
 
Yoga, Anatomy & Physiology Certificate Course.pptxv.pptx
Yoga, Anatomy & Physiology Certificate Course.pptxv.pptxYoga, Anatomy & Physiology Certificate Course.pptxv.pptx
Yoga, Anatomy & Physiology Certificate Course.pptxv.pptx
 
Apcalis Sx 20 Mg Oral Jelly July 2024.pdf
Apcalis Sx 20 Mg Oral Jelly July 2024.pdfApcalis Sx 20 Mg Oral Jelly July 2024.pdf
Apcalis Sx 20 Mg Oral Jelly July 2024.pdf
 
OT Dude's Salary Survey Report July 2024.pdf
OT Dude's Salary Survey Report July 2024.pdfOT Dude's Salary Survey Report July 2024.pdf
OT Dude's Salary Survey Report July 2024.pdf
 
Cyberattacks on Healthcare Systemss.pptx
Cyberattacks on Healthcare Systemss.pptxCyberattacks on Healthcare Systemss.pptx
Cyberattacks on Healthcare Systemss.pptx
 
TheHistroke 340B Product Presentation_MetaBridge
TheHistroke 340B Product Presentation_MetaBridgeTheHistroke 340B Product Presentation_MetaBridge
TheHistroke 340B Product Presentation_MetaBridge
 
Abortion pills for sale in Qatar(+919707208804)Buy Cytotec tablet in Doha
Abortion pills for sale in Qatar(+919707208804)Buy Cytotec tablet in DohaAbortion pills for sale in Qatar(+919707208804)Buy Cytotec tablet in Doha
Abortion pills for sale in Qatar(+919707208804)Buy Cytotec tablet in Doha
 
Top Rated Massage Center In Ajman | Massage Center Deals Sharjah
Top Rated Massage Center In Ajman | Massage Center Deals SharjahTop Rated Massage Center In Ajman | Massage Center Deals Sharjah
Top Rated Massage Center In Ajman | Massage Center Deals Sharjah
 
Yoga Nidra Teacher Training Certification Course
Yoga Nidra Teacher Training Certification CourseYoga Nidra Teacher Training Certification Course
Yoga Nidra Teacher Training Certification Course
 
Automated Feedback in Digital Depression Screening: DISCOVER Trial | The Life...
Automated Feedback in Digital Depression Screening: DISCOVER Trial | The Life...Automated Feedback in Digital Depression Screening: DISCOVER Trial | The Life...
Automated Feedback in Digital Depression Screening: DISCOVER Trial | The Life...
 
Multiple Sclerosis and the Immune System - Plexus
Multiple Sclerosis and the Immune System - PlexusMultiple Sclerosis and the Immune System - Plexus
Multiple Sclerosis and the Immune System - Plexus
 
Extraction Vs non exraction in orthodontics.pptx
Extraction Vs  non exraction in orthodontics.pptxExtraction Vs  non exraction in orthodontics.pptx
Extraction Vs non exraction in orthodontics.pptx
 
Vasundhara Fertility (IVF) Centre Jodhpur
Vasundhara Fertility (IVF) Centre JodhpurVasundhara Fertility (IVF) Centre Jodhpur
Vasundhara Fertility (IVF) Centre Jodhpur
 

Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics

  • 1. Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics
  • 2. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. As enrollment in Medicare Advantage plans increases, healthcare organizations need to be able to anticipate future healthcare financial resources and predict appropriate reimbursement for physicians. Coding Accuracy and Risk Adjustment
  • 3. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to estimate predicted costs for Medicare Advantage beneficiaries, and the results directly impact the reimbursement healthcare organizations receive. The HCC risk adjustment model was originally implemented in 2004, but is becoming more prevalent as value-based payment models gain popularity. Coding Accuracy and Risk Adjustment
  • 4. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The HCC model assigns a Risk Adjustment Factor (RAF) to each Medicare patient as measurement of probable costs, which is then used to adjust capitation payments for patients enrolled in Medicare Advantage plans. Accurate HCC coding and risk adjustment can have a significant impact on healthcare organizations’ financial viability and care delivery. Coding Accuracy and Risk Adjustment
  • 5. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. CMS requires that all qualifying conditions be identified each year by provider organizations. Documentation linked to a non-specific diagnosis, as well as incomplete documentation, negatively affects reimbursement. Healthcare organizations that optimize their EMR, data, analytics, and education can enable better documentation of care for patients with chronic diseases, leading to more accurate HCC risk adjustment coding. HCC Model Complexities and Risk Adjustment Use
  • 6. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The number of Medicare Advantage beneficiaries has continued to rise over the past ten years, with roughly one-in-three Medicare beneficiaries now enrolled in a Medicare Advantage plan. As with starting any new initiative, HCC coding is not intuitive, but accurate HCC coding is necessary for healthcare organizations in order to receive fair compensation. HCC Model Complexities and Risk Adjustment Use
  • 7. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. There are a few highlights to know about 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. Some codes have RAF value. Some do not. Increased severity doesn’t usually increase risk adjustment factor (RAF). HCC codes are not always intuitive. Physicians may require decision support. HCC codes are additive, and some have multipliers. 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. HCC Model Complexities and Risk Adjustment Use > > > > > > > >
  • 8. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Even though the payment model is not intuitive, an organization’s ability to perform well within this model should increase over time. For example, in Figure 1, the table shows sample patient data from a 76-year-old female patient with an RAF score of .448. The two options show how different diagnoses change the patient’s risk score, and, as a result, the annual member payment. The Impact of Appropriate HCC Coding
  • 9. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Impact of Appropriate HCC Coding Impact of Appropriate HCC Coding on Payment Female, age 76, Not: originally disabled, Medicaid, ERSD, or institutionalized, Demographic RAF score = .488 Option 1 HCC Risk Score Obesity 0 Type 2 diabetes, exudative retinopathy .104, 0 Major depression disorder, Single episode, unspecified 0 CHF .323 Asthma 0 Pressure ulcer of right heel, unspecified 0 CHF*DM .154 RAF score: 1.029 Sample MedicareAdvantage member payment,Annual: $9K Option 2 HCC Risk Score Morbid obesity, BMI 42 .273 Type 2 diabetes, w/diabetic retinopathy .318 Major depression disorder, Single episode, mild .395 CHF, class 3 .323 COPD .328 Pressure ulcer of right heel, stage 3 1.204 CHF*DM; CHF*COPD .154, .19 RAF score: 3.633 Sample MedicareAdvantage member payment,Annual: $32K Figure 1: The impact of appropriate HCC Coding on payment
  • 10. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The two different options show a patient of similar complexity but varying diagnoses, which results in vastly different annual member payments. Option one showed a total RAF score 1.029 and an annual Medical Advantage member payment of $9,000. Option two showed a RAF score of 3.633 and a Medicare Advantage member payment of $32,000 annually. While physicians should not change their diagnoses, it is important to code accurately and take credit, where deserved, for serving a complex population. The Impact of Appropriate HCC Coding
  • 11. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The example provides a compelling rationale for organizations to improve their HCC coding accuracy. However, the first step is obtaining accurate data about Medicare populations before trying to make improvements in this space. It may also be beneficial to form a workgroup that is responsible for improving the accuracy of documentation and HCC coding. Driving Improvement Through Interdisciplinary Workgroups
  • 12. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. This workgroup could include members of: • The analytics team • Accountable Care Organization (ACO) team • Clinicians • Clinic managers • Operations • Medical coders. Driving Improvement Through Interdisciplinary Workgroups
  • 13. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Forming the workgroup can help oversee these five key action items necessary for improving HCC coding accuracy: 1. Having an accurate problem list 2. Ensuring patients are seen in each calendar year 3. Improving decision support and EMR optimization 4. Widespread education and communication 5. Tracking performance and identifying opportunities Driving Improvement Through Interdisciplinary Workgroups
  • 14. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 1: Having an accurate problem list Many healthcare organizations have been inputting data in an EMR for years now, resulting in lots of data, and most likely an inaccurate problem list. Ensuring an accurate problem list involves removing duplicative and inactive diagnoses, identifying key areas with discrete data in the EMR, and using a diagnosis preference list to include HCC suffix codes and RAF values as well as prioritize results. Driving Improvement Through Interdisciplinary Workgroups
  • 15. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 2: Ensuring patients are seen in each calendar year Driving Improvement Through Interdisciplinary Workgroups The first step is to identify patients with chronic illnesses who have not been seen during the calendar year and once found, schedule that patient for a visit. One way to do this at a glance is to build a clinical dashboard that provides a snapshot of both EMR and claims data that provides a complete picture of patients not yet seen in a calendar year. Once the workgroup can identify these patients, they can match them with both visit and HCC coding gaps.
  • 16. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 3: Improving decision support and EMR optimization Driving Improvement Through Interdisciplinary Workgroups Although educating providers is necessary to improve HCC coding accuracy, it’s also important to build appropriate coding into the daily encounter workflow. Some potential strategies include having an ACO identifier flagged in the EMR, decision- support tools that can be activated for select populations, and HCC diagnosis alerts for past codes.
  • 17. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 4: Widespread education and communication Driving Improvement Through Interdisciplinary Workgroups Because this is new work and certainly not intuitive, it’s important to educate clinicians. The biggest educational point to drive home to clinicians is not what score they should look for, but the importance of accuracy. Workgroups can educate clinicians on the clinical and financial value of specificity. They can also educate clinic staff about the specifics of the tools and workflows for patient management and reporting.
  • 18. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5: Tracking performance and identifying opportunities Driving Improvement Through Interdisciplinary Workgroups The last, and perhaps most important key initiative of the workgroup is to track performance and identify future opportunities for improvement. Measuring results provides the workgroup with compelling data to bring to stakeholders that shows what improvements were made, such as an increase in average RAF score, improvement in key problem list diagnoses, decrease in the number of members without an annual visit, an increase in the percentage of persistent condition diagnoses resolved.
  • 19. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5: Tracking performance and identifying opportunities Driving Improvement Through Interdisciplinary Workgroups Once the workgroup has data to bring to stakeholders, the next step is to identify future opportunities for further improvements. One place to look for these is by reviewing unresolved persistent conditions for specific populations.
  • 20. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Key Lessons For organizations that are looking to embark on an effort to improve their HCC coding accuracy and risk adjustment, below are four valuable lessons learned: The magnitude and presence of coding accuracy opportunities are not evident without data. Using data to focus efforts helped find topics that were practice and valuable to end users and improve engagement. It is manageable and effective to use the EMR upstream and during encounters. Clinic staff want reports to see how they are doing compared to peers. > > > >
  • 21. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Fair Reimbursement for Serving Complex Patient Populations Although HCC coding accuracy and risk adjustment requires changes to the way healthcare organizations are documenting and coding chronic conditions, doing so can help the organization capture more complete diagnoses, resulting in higher and more appropriate reimbursement and improved care delivery for complex patient populations.
  • 22. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Fair Reimbursement for Serving Complex Patient Populations With increasing Medicare Advantage numbers, healthcare organizations need to improve coding accuracy to remain financially viable. Creating a workgroup that’s responsible for key action items is crucial to the success of this initiative. They can help ensure the organization has an accurate problem list, chronically ill patients are seen once per calendar year, improve decision-support and EMR optimization, educate clinicians and staff, and track performance of the initiatives to share with stakeholders.
  • 23. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Fair Reimbursement for Serving Complex Patient Populations If healthcare organizations appropriately document the complexity of their patients, they are eligible for greater CMS revenue that can then be reinvested to better meet the needs of their patient population.
  • 24. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  • 25. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. Five Action Items to Improve HCC Coding Accuracy and Risk Adjustment With Analytics ACOs: Four Ways Technology Contributes to Success Health Catalyst Editors Understanding Risk Stratification, Comorbidities, and the Future of Healthcare Eric Just, SVP of Product Development Healthcare Data Management: Three Principles of Using Data to Its Full Potential Sean Whitaker Why Clinical Quality Should Drive Healthcare Business Strategy Health Catalyst Editors Linking Clinical and Financial Data: The Key to Real Quality and Cost Outcomes Bobbi Brown, MBA, SVP
  • 26. © 2019 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes needed to improve population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 65 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. Health Catalyst was recently named as the leader in the enterprise healthcare BI market in improvement by KLAS, and has received numerous best-place-to work awards including Modern Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for Millenials, and a “Best Perks for Women.”