And the Award for HCC Excellence Goes To …


It’s that time of year! No, I’m not talking about holiday preparation. I’m talking about the year-end activities you, as coding professionals, should be doing to ensure your HCC process is truly excellent: prior HCCs are captured in your records, documentation reflects the details that help your coders code to the highest level of specificity, problem lists are being maintained, claims are promptly submitted, and you have a low or zero denial rate. Doing all of these steps will ensure the RAF score for your organization reflects the highest accuracy supported by the clinical documentation in the records.

So, what do we need to do to achieve this? Here are a few suggestions:

1. Compare established patients’ data: Did patients that were seen in 2019 or 2020 and again seen in 2021 have HCCs in those years that they did not have in 2021? Review this year’s encounters to determine if there are any HCCs that went unreported and unclaimed or reported in error. While you’re looking at these patients, address the accuracy of the patient’s problem list. Does it reflect the active conditions? Are there omissions? Are there conditions that need to be deactivated? Also look at outside records for any conditions that the provider may need to examine during the patient’s next visit.

2. Submit revised claims: If your perusal of the encounters found unreported conditions or erroneously submitted condition, now’s the time to submit the claim or resubmit the revised claims, respectively.

3. There’s still time: Are there patients that were seen in 2019 or 2020 that have not been seen in 2021? Alert scheduling or the patient follow-up specialist to pursue these individuals and try to schedule them before year end.

4. Prepare for next year: You already have your established patients list and you’ve already vetted their conditions. Provide patient profiles (including conditions from outside records) for those patients who are scheduled for early 2022 appointments. This will allow the providers to refresh their documentation on these conditions and focus on any new ones during their visit with the patient.

5. Reward the providers and their support team: Now, this is probably one you’re wondering about. What’s better than receiving an Emmy? Well, it’s an Emmy for HCC Excellence. While you are digging through your established patients, you will find providers who have impeccable documentation to support their HCC diagnoses. It is complete, accurate and up-to-date. My suggestion is to make a fuss and reward those providers who deserve a shout-out. Shop for a desktop trophy that can be engraved to recognize up to the top 3-5 providers for their HCC excellence. Don’t leave out their support team, such as the provider’s CMA, NP, and coder. They, too, should receive a trophy, perhaps a different size or a lapel pin that recognizes them for their contribution to the accuracy of the patient’s profile and RAF. Be certain to coordinate this activity with practice administration. They may also wish to include one or two other criteria.

I recognize that none of these will be a “breeze.” But, if you wish to demonstrate the value you bring to your organization, it’s worth the effort. Happy New Year!


HCC Problem Lists: Challenges and Opportunities
Are your problem lists a problem? Providers have enough documentation burdens already. For providers, maintaining problem lists takes a backseat to patient care…as it should. However, an up-to-date and accurate problem list can facilitate patient safety and care as well as being a key aspect of some risk adjustment contracts. HIM and CDI specialists have a role to play.

HCC Problem Lists: Challenges and Opportunities will address your role in supporting this critical aspect of clinical documentation. Learn more here.

About the Author

Rose Dunn
Rose Dunn is the Chief Operating Officer at First Class Solutions, Inc., a healthcare information management leader since 1988. Rose is the author of “The Revenue Integrity Manager’s Guidebook” available from the National Association of Healthcare Revenue Integrity and other books on Coding Management and Auditing from HCPro. She engaged herself in ICD-10 more than 10 years before it was implemented. She is assisting Libman Education in the development of an HCC educational program. Rose holds a BS and MBA from Saint Louis University.

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