5 ways of Improving HCC Coding Accuracy & Risk Adjustment Solution with Analytics

5 ways of Improving HCC Coding Accuracy & Risk Adjustment Solution with Analytics

The Centers for Medicare & Medicaid Services (CMS) is part of the Department of Health and Human Services (HHS) that employs the Hierarchical Condition Category (HCC) risk adjustment method to predict Medicare Advantage beneficiaries' costs. The outcomes have a direct influence on the payment healthcare organizations receive.

Healthcare organizations that improve their electronic medical records, data, algorithms, and provider training can improve care documentation for patients with chronic diseases. It results in accurate HCC risk adjustment coding and more effective remuneration for better outcomes.

Coding a correct Risk Adjustment Factor (RAF) score has a direct influence on Medicare beneficiaries' premiums for the

next year. Therefore it's critical that coders thoroughly grasp and follow the HCC coding standards to enter clinical diagnoses and healthcare services as universal medical alphanumeric codes.

Do you want to know how to enhance the HCC coding accuracy and risk adjustment? Please continue reading to find out how to improve it.

1.Make an Accurate List of Issues Health organizations must refine their electronic medical records by removing identical and inactive diagnoses to avoid inaccurate listing. Creating an accurate diagnostic preference list with HCC suffix codes and RAF scores is necessary to improve HCC Coding and Risk Adjustment Solution.

2.

Ensuring Patients Are Seen Throughout the Year

Health organizations must create a clinical dashboard that gives an overview of electronic medical records and claims data to get a detailed overview of patients with chronic diseases who haven't been seen during the current year. Such a dashboard helps in finding the HCC Coding gaps.

3.

Enhance EMR Optimization and Decision-making Assistance

The accurate HCC Coding depends on detailed provider documentation of a patient's diseases in the Electronic Medical Record (EMR) and accurate diagnoses coding. Educating providers about risk-based contracts work and the importance of incorporating accurate coding in daily workflow enhances HCC Coding. It can be achieved by marking an ACO identification in the EMR, activating decision-support tools for select groups, and HCC diagnostic warnings for previous codes.

4.

Increase Awareness and Communication

Conducting workshops can educate caregivers about the clinical and economic importance of specificity, a test's capacity to identify an individual with the disease as positive. Also, educating clinic staff about specifics tools and plans for patient care and documentation is essential. The awareness and communication should be focused on the

significance of accurate risk adjustment to support finance provision and compliance.

5.

Keeping Track of Performance and Finding Gaps for Improvement Monitoring data highlights the changes in RAF scores, diagnoses list, and other determinants that help track performance and find areas for improvement. Working together with all stakeholders, the successful HCC Coding and Risk Adjustment can be achieved for future reimbursement and improved care delivery.