In our extensive experience working with population health teams, we’ve seen them grapple with several challenges when it comes to HCC coding. In this series of blog posts, we’ll share some case studies that demonstrate how top-performing medical groups overcame these challenges to improve their HCC coding accuracy and processes.
This week we’re featuring a multi-specialty, physician-led, Integrated Delivery Network (IDN) medical group based in Florida with over 200 providers. This group participates in MSSP and Medicare Advantage.
The organization felt they were leaving something on the table with their HCC coding. They knew coder review could identify HCC coding opportunities but had limited staff available to tackle this process. With over 200 primary care providers and no dedicated HCC coding resource, implementing a coder review seemed like an impossible task. This group needed to find a way to make an impact in concurrent HCC capture without additional staffing.
The organization decided to perform an analysis to understand their volume of HCCs and identify the greatest opportunities for improvement. They set a goal of implementing a manageable plan to start small and work within their current resources.
The first step was to implement technology to assist with both the initial analysis and an ongoing concurrent coder review process. The organization was then able to “borrow” a single coder from another area, and task them with reviewing HCC coding encounter data by payer, provider, location, HCC code, and frequency from the past 30 days using RCxRules reporting. They were then able to utilize this data to identify high priority HCC codes that had a high likelihood of sufficient provider documentation but lacked coding accuracy. They identified these four HCC codes as meeting the above criteria:
Patient has history of HIV (HCC 1)
Amputation Diagnosis Not in Current Year (HCC 173, 189)
Patient has history of Artificial Openings for Feeding or Elimination (HCC 188)
Patient has history of Morbid Obesity (HCC 22)
With this knowledge, they were able to configure RCxRules HCC Coding Software to filter and prioritize high value claims with these HCC codes for coder review. With limited resources, it was imperative that they got the most out of their single coder.
Within the first 4 months this group was able to add one of the above targeted HCCs to one out of every four claims reviewed, because the clinical documentation was robust enough to do so. This resulted in the addition of 444 HCC codes that would have otherwise been missed, equating to an increased RAF value of $1.2 Million*.
Set up a meeting to learn how RCxRules can help your organization overcome these challenges and more to improve your HCC coding accuracy and processes.
*Medical group’s share of increased RAF value is based on their payer contracts.