What advice can you provide to help coders work collaboratively with CDI specialists, physicians/other providers, auditors, and data analysts to ensure accurate and complete HCC capture?
Hierarchical Condition Categories (HCCs) are utilized by Medicare Advantage and Affordable Care Act payers for approximately 30 million individuals currently. Use of HCCs is projected to grow significantly in coming years and individuals with in-depth knowledge and command of the HCC system will be needed to ensure coding is accurate, supported by documentation, and that reimbursement is appropriate. We asked six experts what they thought about the challenges and opportunities provided by the accelerating move toward risk adjustment payment models.
In the fifth installment of this discussion, the experts answer the question, “What advice can you provide to help coders work collaboratively with CDI specialists, physicians/other providers, auditors, and data analysts to ensure accurate and complete HCC capture?” (See the series in its entirety here.)
“Create an environment where everyone can share their knowledge.”
MURPHY: Create an environment where everyone can share their knowledge. For example, coders can educate others on how physician documentation translates to the coded data (and why it may not translate). It may be obvious to a clinician for instance that a patient has diabetes, but a coder may not be able to code that condition when the only documentation is an elevated hemoglobin.
DUNN: Collaboration can be difficult when coders work remotely. That’s why it’s important for remote coders to come onsite on a routine basis for face-to-face meetings. In addition, collaboration must go beyond internal staff to include health plans. Providers need to be able to connect the dots in terms of why they need to document a certain way.
“There needs to be an enterprise-wide understanding of the role of hospital-owned physician practices in achieving HCC compliance.”
-Bonnie S. Cassidy
CASSIDY: Create a multi-disciplinary CDI program with physician queries in the physician offices. There needs to be an enterprise-wide understanding of the role of hospital-owned physician practices in achieving HCC compliance. Involve all of the key players from care delivery, finance, CDI, coding, patient access, and others to ensures the team’s understanding of a goal for accurate payments based on clinical complexity and denials prevention. The opportunity to capture HCCs and impact hospital payment often falls directly on office-based physicians.
Close the care gaps across the enterprise. Make quality patient care the number one priority, and everything else will fall in line.
MALONE: Think of yourself as a team. It’s about relationship-building. There’s nothing that puzzles me more than a provider who ignores queries. If the query isn’t clear, let the coders and CDI staff know. Ignoring the query doesn’t help anyone. Providers should be part of the education process to create more cohesion. The key component in all of this is TEAM!
TAYLOR: Respect each other’s expertise. Don’t point fingers.
“It’s a revenue cycle team. One person can’t know everything about everything.”
-Laurie M. Johnson
JOHNSON: It’s a revenue cycle team. One person can’t know everything about everything. The more you collaborate, the more you learn. Standardize coding and documentation guidelines across all practices system-wide. Also provide HCC training for non-coders (e.g., medical assistants, billers, office managers, and front office staff) to explain how money will flow differently throughout the practice and the potential financial and data quality impact.
Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, President of Cassidy & Associates
Rose T. Dunn, MBA, RHIA, CPA, FACHE, Chief Operating Officer, First Class Solutions, Inc.
Laurie M. Johnson, MS, RHIA, FAHIMA, Senior Healthcare Consultant, Revenue Cycle Solutions, LLC
Donna Malone, CPC, CRC, Director of Coding and Provider Education, Enterprise Risk Adjustment, Tufts Health Plan
John Murphy, MBA, Principal, Risk Adjustment Consulting
Earshler Taylor, RHIA, RHIT, CCS, CDIP, CPC-I, COC, CPC, Chief Executive Officer, Earshler Taylor Consulting
Lisa A. Eramo, MA, moderator and freelance writer
Fundamentals of HCC Coding
Go beyond just the diagnoses — really understand the methodology behind HCCs! Prepare for the future of healthcare reimbursement with “Fundamentals of HCC Coding,” by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE. Learn more here.