The RCxRules Blog

Overcoming HCC Challenges in 2022: Provider Burnout, Staffing Challenges, and Coding Gaps

With 2022 underway, it’s clear the impact of value-based care on the bottom line of medical groups across the country is continuing to grow. Succeeding in value-based care isn’t easy—and ensuring you have a consistent and predictable revenue stream is crucial. Thankfully, there are ways to stay a step ahead as the world continues to move towards value-based care. These are some of the biggest challenges we anticipate for the year ahead, and how to overcome them.

Provider Burnout

Two years into the pandemic, providers are stretched thin. Physicians across the country have done a heroic job throughout these challenging times, and it’s no wonder that burnout is at an all-time high. On top of the added obstacles of the pandemic, providers also often struggle to translate the care provided into HCC codes. They went to medical school to become doctors, not coders. Provider education is a good place to start, but providers need support to truly improve RAF scores. That’s why the RCxRules HCC Coding Engine works with your coders, so there’s no additional work required from already overburdened providers.

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Staffing Challenges

We’ve all heard about the Great Resignation—and coding teams have not been spared from staffing challenges. Finding and retaining qualified coders is increasingly difficult, and it’s more important than ever to make the most of the staff you have. We understand that coders have a wealth of specialized knowledge—their expertise shouldn’t be wasted on reviewing routine encounters. To optimize their time and productivity, our HCC Coding Engine identifies the critical, high-value HCC encounters that warrant full coder review.

HCC Coding Gaps

Physicians are much better at clinical documentation than HCC coding. We’ve found that 1/3 of encounters flagged by the HCC Coding Engine are underreporting HCC codes when compared to the physician documentation. This means your physicians aren’t getting credit for the documentation they entered and the care they provided. Overreporting is also a significant concern—particularly in light of the Department of Justice cracking down on healthcare fraud. The HCC Coding Engine automatically identifies potential gaps and directs them to a coder for review, ensuring that encounters are neither over-coded nor under-coded and go out correctly every time.

To learn more about our concurrent HCC coding solution, set up a 1:1 meeting today.

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