Rapid RAF without more Staff (quickly identify risks/revenue)

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Hierarchical Condition Category (HCC) coding is very different from ICD-10 CM & CPT/HCPCs coding.  And while it’s been around for quite some time, it is still a very specialized area that lacks resources (staff) with the knowledge on the impact of improper reporting of these codes on the current and future financial “health” of the hospital, physician’s office, or health system.  Now there has been another CMS/OIG announcement in the February 2022 issue of the AAPC Healthcare Business Monthly that the following HCCs are being scrutinized due to improper coding/reporting.  There is no time to delay in creating a plan for extra attention to:

  • History of Cerebral Infarction vs. Cerebral Infarction with Residual Deficits
  • Old Myocardial Infarction vs. Acute Myocardial Infarction
  • Acute/Chronic Deep Vein Thrombosis vs. History of Deep Vein Thrombosis
  • Major Depressive Disorder
  • Hypertension, Chronic Kidney Disease, and Heart Disease
  • Diabetes with Complications

With the continued focus on HCC categories, it will be more important than ever for hospitals, physician offices, and health systems (with risk-based contracts) to be sure they understand how many of their patients are being reported with these codes/conditions/HCC categories.  Along with what potential risk these diagnoses could be creating for an audit/review of their HCC coding and patients Risk Adjustment Factor (RAF) scores.

If you are an HCC coder, then you know of Risk Adjustment Data Validation (RADV) audits.  But are you ready for one should CMS select your Medicare Advantage Organization (MAO)?  The seven recommendations in this month’s issue of the AAPC Healthcare Business Monthly to prepare for an audit are: be organized, prioritize, and retrieve the best charts, know coding guidelines, follow CMS rules for submissions, submit your best charts, review results, and make changes if necessary, and be prepared to appeal denials.

But how do you complete yet another task with the same staffing?  How do you quickly identify the best charts?

By using smart technology.

revealMD HCC RAF technology quickly locates/isolates down to the patient level (and the providers reporting) these specific ICD-10CM codes by the HCC categories and see the actual risk. This would give the system with limited resources (staff) the ability to quickly focus their HCC efforts on this subset of patients/providers to be sure that there is documentation to support the codes reported.  And if the documentation does not meet the standard, then give the coders/auditors/educators the opportunity to educate the providers on HCC requirements and provide documentation improvement.

Self-identifying an issue and correcting, along with resubmitting to MCR can protect the system if audited. It shows effort on the part of the health system/hospital/practice, and in my experience can truly stop an audit from occurring.  Additionally, you can report the data output from REVEAL RAF to identify potential areas of risk, then also track and trend over time showing plans/efforts/improvements made.

Please visit our website for more information or to schedule a demo.

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