The RCxRules Blog

Fewer Patient Visits Due to COVID-19 Means Fewer HCC Opportunities

It is no secret that the COVID-19 pandemic has uprooted life in 2020. From rattling the economic landscape to transforming the way we gather with friends and family, people across the country are missing out on many of the interactions, connections, and opportunities that once seemed like everyday essentials—healthcare included.

In an effort to maintain social distance, avoid unnecessary risk, and free up provider capacity for treating COVID-19 cases, many individuals across the country have opted out of their typical inpatient, outpatient and physician service visits in 2020. Across the country, practices reported 40% to 60% decreases in patient volume during the spring and early summer of 2020. Most of these patient visits will not be rescheduled.

Not only does deferral mean patients are missing out on important healthcare, but it also results in reduced claims and diagnoses overall, and consequently fewer opportunities to identify and capture HCC conditions that could impact RAF scores. Compared to 2019, both the number of claims per person and the number of diagnoses have declined significantly—a trend that experts suggest will likely continue throughout the remainder of 2020 as the pandemic lingers.

In fact, fewer claims in 2020 could lead to an estimated 3% - 7% reduction in risk scores and payments in 2021—which isn’t good for practices, patients, or the health of communities as a whole. When asked about financial projections and outlook, more than half (58%) of healthcare organizations state that it could take up to two years for their revenue levels to stabilize to pre-pandemic levels. With so much uncertainty in our shared future, it’s no wonder only 20% of healthcare organizations feel confident in complete financial recovery moving forward into 2021.


How to Make the Most Out of the Data You Have: One Small Change with a Big Impact

Given this backdrop, it has never been more essential for health systems and practices to ensure patients with the most complex care needs are scheduled for in-person or telehealth visits and that all HCC codes are fully captured. However, amidst end-of-year demands, staffing challenges and the continued uncertainty of the pandemic, we know that is a strategy that is easier said than done.

Catching missed HCC coding opportunities can usher big results: for example, catching even a small increase in HCCs could potentially increase a practice’s RAF value by several hundred thousand dollars a month. In addition to making sure no opportunities are overlooked, RCxRules software also checks to ensure HCC coding is not inflated, ensuring coding is done in a highly compliant way.

While the potential for impact is vast, this coding review truly is quick and simple to implement, allowing you to start capturing more HCCs on day one. The power of RCxRules’ automated review, coupled with our ability to fine-tune the HCC target list, means a small number of coders can have a huge impact on a large organization. Backed by real time insights into how many HCC codes are added and removed because of this process, the value of the solution speaks for itself. In fact, many of our clients see returns that pay for the cost of the software in only a few weeks.

Ready to make this small change? We’re here to help. Reach out to set up a 15-minute meeting to learn more, do not miss another HCC coding opportunity.


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