Readers Write: Easing HCC Coding Adoption by Using Insights and Assessment for More Accurate Data

Easing HCC Coding Adoption by Using Insights and Assessment for More Accurate Data
By Shahyan Currimbhoy

Shahyan Currimbhoy, MS is vice president of product of Edifecs of Bellevue, WA.

Healthcare provider organizations that are participating in Medicare Advantage plans are acutely focused on the adoption and execution of Hierarchical Condition Category (HCC) coding. HCC is a healthcare risk adjustment model that is used to predict the healthcare costs of individuals or populations based on medical conditions. Adoption requires disciplined and accurate documentation and coding of all relevant medical conditions to properly reflect the health status of patients. Accuracy is critical. Even the slightest inconsistency or error can impact risk scores and subsequent reimbursements to providers.

HCC coding is an important model for healthcare reimbursement risk adjustment because it offers the benefit of accurately predicting healthcare costs. Unfortunately, as it has been put into practice, it has elevated some operational challenges. It’s no secret that coding has long-been an administrative burden on the healthcare system. Over time, we’ve learned that automated, integrated, and system-wide technology can help reduce these burdens. In the present evolution of our healthcare system, we also know the viability of value-based care (VBC) desperately depends on alignment between documentation, provider engagement, and claims coding.

The implementation of HCC coding requires a thoughtful approach. If done right, organizations could quickly see opportunities to refine and improve the encounter documentation process and care delivery.

Your HCC Coding Approach: Collaborate with Clinicians

As care teams recognize HHC coding as a critical component of an organization’s business model, identifying the right deployment approach is an important early step. Each health system will take a different approach, but change must be met with ease and collaboration. Organizations that attempt to move into alternative payment models (APM) by flipping the switch overnight on new processes or technologies will encounter pushback from care teams and coding staff. Value-based payment participants will have a better outcome if they ease into the transition, including starting with tools that are made for VBC, and weaving them into the existing team structure and processes.

Care teams and coding staff will have questions. Will HCC coding be addressed before, during, or after the visit? Will coders and clinicians collaborate in person or electronically? Consult your clinicians before determining the best approach. Excluding them will undoubtedly result in a missed opportunity to best understand how strategy could impact their day-to-day workflows, which can lead to a more challenging implementation process.

A collaborative approach will result in more accurate coding in the long run, playing a huge role in reducing the time providers are spending confirming or rejecting a suspected condition.

Coding Insights and Provider Education Support Entering High-Risk Sharing Arrangements with Confidence

Even with automation and collaboration tools, care teams that have incorporated HCC can still find themselves coding inconsistently. For leadership to understand where education and resources are needed, there needs to be provider-level visibility of coding efficacy. Without data-driven insights into provider quality risk operations, this can prove challenging.

With the proper sources, providers can build patient registries, identify where the patients are, and build standard care pathways to ensure that patients are getting proper care. Leadership can gather the clinicians to share knowledge and identify variations in care. Treating HCC coding as a discipline, rather than as an administrative or financial function, helps ensure alignment between providers and the coding team, which drives improved patient outcomes.

Organizations with confidence to move into high-risk sharing arrangements can use automation and natural language processing (NLP) to drive scalability, collaborative tools that allow care teams to work in unison, and performance analytics to help the whole care team continue to improve.

Using “MEAT” to Fully Assess New Conditions Against Patient History

VBC payment models often require a comprehensive understanding of a patient’s medical history, always culled from various sources and locations. Consolidating diagnostic codes linked to HCCs becomes difficult when a patient is treated at multiple departments within a clinically integrated network (CIN) with separate EMRs. In today’s state of financial resources, the right integrations and automation tools are key.

Organizations are empowering clinical review specialists by giving them a comprehensive view of each patient’s medical history, as well as the tools needed to help identify the gaps in care. If medical history is reviewed prior to an encounter, it can reduce some of the burden on clinicians during the patient visit. With the comprehensive view and additional time, providers can better assess new potential conditions using the acronym “MEAT” as suggested by the AAPC (monitoring, evaluating, assessing/addressing, and treating).

MEAT serves as the connective tissue between documentation, provider intervention, and claims coding, and is essential for any reliable risk adjustment program. VBC relies on this alignment, confirming that money is flowing to organizations that are most at risk, and ensuring that patients with chronic conditions are served efficiently. Combined with tools that simplify HCC recapture, such as artificial intelligence and machine learning, these approaches can save time across the care team and ensure care continuity and revenue capture for chronic disease management.

Stop Using Old Solutions for New Practices

Automation tools and assessments like MEAT help care teams, providers, and coders ensure that HCC coding accurately reflects the true burden of patient populations. Without the necessary systems and technology infrastructure in place, following the guidelines in practice can be challenging. Health systems that are incorporating VBC arrangements often expect to solve new problems with old solutions, and that is just simply not realistic. Organizational efficiencies leading to increased clinician satisfaction, improved financial performance, and better clinical outcomes can be realized with the right operational components to support automation, visibility, and collaboration for both provider organizations and health plans.