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Preparing for an HCC Audit: Proactive Reviews

by Rose T. Dunn, MBA, RHIA, CPA, FACHE

Are you surprised by the denials and audits your organization is experiencing? We shouldn’t be surprised but monitoring everything is tedious and time-consuming. Who has excess staff to do it all?

Often we get caught up with all the day-to-day distractions that we forego the opportunity to identify potential audit targets in our own organization and proactively address them before it is too late. There are ways to avoid these surprises without too much effort.

Are you conducting reviews of your coding and billing activities on a routine basis? If not, consider doing small samples to see if there is an issue worth pursuing. It doesn’t need to be a one-person effort. Take a half-hour and pull together 4-5 team members and look at 3-5 charts each for a few elements, e.g.

  • Is each encounter note for this year signed, dated, timed, and does it show the provider’s credentials?
  • Is the patient’s name and another identifier on every page? These should be there if you’re on an electronic health record (EHR) but if you’re still on paper, you may find some voids here.

 

I would encourage including a treat for those participating such as popcorn or pizza. This makes compliance reviews fun!

More time is required to review a sample of encounters for coding accuracy and completeness. Use the risk adjustment data validation (RADV) tool for items you can audit and do one or two each month.

For those of you that are being proactive, what are doing with your findings? Do you document the findings? Do you share the findings? With whom?

 

Introduction to HCC Coding
Complete and accurate coding for Hierarchical Condition Categories (HCCs) presents an opportunity for improved data quality and appropriate reimbursement. Learn how from nationally recognized HCC expert, Rose T. Dunn, MBA, RHIA, CPA, FACHE.

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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