by Rose T. Dunn, MBA, RHIA, CPA, FACHE and Laurie M. Johnson, MS, RHIA, FAHIMA
Hierarchical Condition Categories (HCCs) are utilized by Medicare Advantage and Affordable Care Act (Obamacare) payers for approximately 30 million individuals currently. Use of HCCs is projected to grow significantly in coming years. Join us for a discussion of HCCs by two industry leaders: Rose T. Dunn, MBA, RHIA, CPA, FACHE, and Laurie M. Johnson, MS, RHIA, FAHIMA.
Laurie: Rose, you’ve been speaking on HCCs for some time now, why do you think hospital coding professionals should know more about HCCs?
Rose: Hospital coding can make a significant difference in the reimbursement to their medical staff members, Accountable Care Organization (ACO) or Shared Savings program serving Medicare Advantage members.
Beyond coding the principal and significant secondaries, coding all co-morbidities, regardless of how insignificant, that were addressed during the stay can supplement the profile of a member with additional HCCs that add to the overall reimbursement (risk adjustment factor) for the members.
Now a question for you Laurie: you have also been in the industry quite some time, do you think that we’ll see hospital coding professionals start to infiltrate the physician office coding arena in either a coding or documentation improvement capacity?
Laurie: I think we will. I have seen hospitals buy physician practices and soon realize that physicians do not assign high quality diagnosis codes through the electronic health record. It is a missed opportunity and too important to ignore.
I was recently doing a presentation on HCCs and some physicians were bitterly complaining about this task. I sympathize with them. My analogy is that no one would ask me to suture a laceration or do surgery so we should not ask physicians to code. This is a job for coders!
As hospitals are more involved on the professional side, my hope is that hospital administration staff will realize that skilled, credentialed coders are a valuable asset.
Rose T. Dunn, MBA, RHIA, CPA, FACHE Rose Dunn is the Chief Operating Officer of First Class Solutions, Inc., a healthcare information management leader since 1988, offering professional consulting services in health information management operations and information governance issues, as well as coding support, coding quality reviews, privacy/security guidance, temporary (interim) management, revenue cycle oversight, and accreditation preparation. Rose is the author of Libman Education’s online course: Fundamentals of HCC Coding as well as “The Revenue Integrity Manager’s Guidebook” available from the National Association of Healthcare Revenue Integrity and other books on coding management and auditing. Ms. Dunn holds a B.S. and M.B.A. from Saint Louis University.Contact Rose at 314-209-7800 or [email protected]
Laurie M. Johnson, MS, RHIA, FAHIMA Laurie M. Johnson is a senior consultant at Revenue Cycle Solutions, LLC, a revenue cycle consulting firm specializing in revenue cycle assessments and work plan implementation; interim management with focus on process improvement; and revenue cycle education for hospitals and physician practices. Laurie is a past president of PHIMA and author of clinical coding articles for Journal of AHIMA and ICD-10 Monitor.