Using Telehealth to Mitigate the Impact of COVID-19 on your HCCs


by Rose Dunn, MBA, RHIA, CPA, FACHE, FHFMA

In addition to the terrible human cost of the COVID-19 virus and the general impact it is having on the healthcare industry, there are two ways in which the pandemic may affect your HCCs.

  • With people being told to stay home, the reduced number of visits to providers means there is a good chance that your per member per month (PMPM) reimbursement may drop if your practice or ACO is being reimbursed via HCCs.
  • Unfortunately, given the risk that the elderly have with coronavirus, your patient population may be less in number, especially if you are located in an area where there has been a high death rate.

How can your practice stem the impact? Telehealth may provide one answer.

Under the CARES Act, telehealth visit options have been expanded and allow you to check your patients’ current conditions and update their health risk assessments (HRA) for the annual wellness visit or any other visit type. Telehealth visits can occur virtually anywhere so you can reach out to your patients if they are seasonal birds and live in different regions of the country or world during different times of the year. (Note that your practitioner needs to be licensed in those states for that service.) Recognize that some of your patients may not be able to manipulate the technology necessary for a successful telehealth visit.

If you are working in the office and have access to the patient’s records, prepare for the visit by creating a log of all the conditions that the patient has had in the last 2 years or more. Finally, make sure your claim system editor and clearinghouse have been updated to accept the new codes. Prioritize those patients you have not seen since January.

There are codes available to code the visit as audio only vs. audio and visual. New and established patients may participate in telehealth visits.

Good luck and stay well!

 

HCC: Fundamentals of Hierarchical Condition Categories
Prepare for the future of healthcare reimbursement with HCC: Fundamentals of Hierarchical Condition Categories, by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE. 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.

2 thoughts on “Using Telehealth to Mitigate the Impact of COVID-19 on your HCCs

  1. Kristy Phillips - June 5, 2020 at 2:30 pm

    Thank you for your information related to coding and telehealth. We have had difficulty finding information related to capture of HCC’s with telehealth visits, during and after the pandemic. Can you provide any information to support the capture of HCC with telehealth? In the past there seemed to be a limitation of capture through this means but with the expansion of acceptable codes for these visits, we need to share any support for coding capture with our providers. Thanks in advance for any information related.

    • Rose Dunn - June 8, 2020 at 4:55 pm

      Thanks to Kristy for this question:

      Thank you for your information related to coding and telehealth. We have been limited in finding information related to capture of HCC’s with telehealth visits, during and after the pandemic. Can you provide any information to support the capture of HCC with telehealth? In the past there seemed to be a limitation of capture through this means but with the expansion of acceptable codes for these visits, we need to share any support for coding capture with our providers. Thanks in advance for any information related.

      The relaxation of the telehealth rules during this pandemic (and anticipated to be extended to some extent after the pandemic ends) encourages us to code our cases with the same detail as any other encounter. This means that we need to remind our providers to conduct and document a thorough history and assessment of prior and any current conditions so we can code them! Additionally, there may be a decrease in newly identified HCCs due to the use of telehealth because our providers may not be able to assess the degree of some physical conditions. This will be more commonly true when telephone-only telehealth visits have occurred.

      One of my colleagues, Jan Trumbo, RHIT, shared the April 10, 2020 CMS Notice: All Medicare Advantage, Cost, PACE, and Demonstration Organizations

      SUBJECT: Applicability of diagnoses from telehealth services for risk adjustment The 2019 Coronavirus Disease (COVID-19) pandemic has resulted in an urgency to expand the use of virtual care to reduce the risk of spreading the virus; CMS is stating that Medicare Advantage (MA) organizations and other organizations that submit diagnoses for risk adjusted payment are able to submit diagnoses for risk adjustment that are from telehealth visits when those visits meet all criteria for risk adjustment eligibility, which include being from an allowable inpatient, outpatient, or professional service, and from a face-to-face encounter. This use of diagnoses from telehealth services applies both to submissions to the Risk Adjustment Processing System (RAPS), and those submitted to the Encounter Data System (EDS).

      Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face requirement when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication. While MA organizations and other organizations that submit diagnoses for risk adjusted payment identify which diagnoses meet risk adjustment criteria for their submissions to RAPS, MA organizations (and other organizations as required) report all the services they provide to enrollees to the encounter data system and CMS identifies those diagnoses that meet risk adjustment filtering criteria.

      In order to report services to the EDS that have been provided via telehealth, use place of service code “02” for telehealth or use the CPT telehealth modifier “95” with any place of service.

      Questions can be addressed to [email protected], please specify, “Applicability of telehealth services for risk adjustment” in the subject line.

      Kristy, I hope this provides some light on your question.
      Rose