Volume to value. If there was ever a reason to prioritize, understand, and prepare for the shift in healthcare’s reimbursement models, this is it: leaders in healthcare expect value-based care and risk-sharing payment models to be the most transformative force in the healthcare industry over the next five to 10 years — more than scientific innovation — according to a study shared by Becker’s Hospital Review.
Healthcare’s shift toward high quality, patient-centered care is a long and winding road with hard fast deadlines, complicated rulings, complex choices, and way too many acronyms — yet one of the best places to start happens also to be one of the most important ways to gather thorough data and learn the true cost of care: HCC coding.
To lay the groundwork and understand the basics of HCC, check out our webinar on the ABCs of HCC. Then you're ready to move HCC Coding from the back burner to the front burner, and maybe even turn up the heat.
Below you’ll find out why and where to start with prioritizing HCCs. If you think you're ready to start, check out our eBook that explains the basics of HCC coding.
HCC requires us to tell the whole story. In order to fully understand the patient's needs, the provider must document demographic factors that may affect the management of the patient or the patient's response to care. MACRA initiatives reward providers for reporting information about their practice and patient population, reimburse accordingly so that providers achieving good outcomes are rewarded and acknowledged. Start by working to increase engagement among your patients. With the changes in healthcare, there is a big shift toward patients assuming more responsibility for their health care.
Medical coders can only assign ICD-10 codes based on the content of the provider documentation. If the provider documentation is lacking, the patient’s complexity is not accurately represented and the risk is not accurately reported.
ICD-10 has greatly expanded the code set; this allows your coders to report the diagnosis to the highest level of specificity which highlights the complexity of care required for that patient. When a provider captures the full scope of work that they are doing for the patient it will depict how the patient is going to be managed.
Capturing the HCC codes documented during qualified patient encounters is imperative to ensure accurate and complete payer payments. Many plans are already using HCCs as the basis of Risk Adjustment - from Medicare Advantage, Medicare Shared Savings Programs, Comprehensive Primary Care plus, and even select private plans. Making the shift to HCC coding will accurately reflect the cost of care and add to your bottom line.
We've posted a few blog posts on the importance of having your medical coders constantly learning—but their job is also demanding and time-consuming. The priority must come from the executive level within your provider practice or healthcare organization. If the leaders do not understand the importance of HCC coding, it’s going to be pushed to the back burner. It’s the responsibility of leadership to relay feedback to the provider and ensure correct and complete information in the medical record which will make a positive impact.
The Bottom Line
It may seem difficult to take the first steps toward value-based care, but organizing care around the patient and shifting toward the value-based model is attainable and merely a matter of making the time and setting the priority for your providers and medical coders to follow.