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Inaccurate HCC coding can lead to significant financial implications and variability in Risk Adjustment Factor scores. A new infographic released by PYA illustrates why coding accuracy is paramount and how implementing a best practice HCC “periodic checkup” is essential to the solution.
“Providers participating in a Medicare Advantage or other risk-based healthcare plan whose payment is tied to money the plan receives should have a vested interest in accurately documenting and capturing diagnosis codes for each patient,” said PYA Healthcare Consulting Principal Lori Foley. “Accuracy in risk capture not only leads to a better determination of the health status for a population, it also results in correct and accurate payment.”
PYA’s infographic, “The Core of Risk Management: Implement an HCC Best Practice—PYA’s HCC Checkup,” demonstrates for providers the importance of accurate documentation and diagnosis code capture for success in their risk-based contracts and for quality of care management of their patients. It advocates for establishing a best practice, or HCC Periodic Checkup, which can help providers overcome common coding and documentation errors that lead to inaccuracies and the resulting financial impact.
“Risk-based healthcare plans depend on the diagnosis codes reported by providers to build the health-risk profile of each beneficiary; and risk scores are used to adjust payments,” said Foley. “As shown in the infographic examples, a change in the risk score can significantly affect the total payment received as part of the program.”
Less than thorough HCC patient coding is often undetected, therefore an assessment by an independent and objective third party with the right data analysis tools can pinpoint areas of deficiency. Conducting periodic checkups helps organizations determine any corrections to their risk-adjustment factor scores, potential underpayments, or increased risk of overpayments that need addressing prior to the annual governmental audit.
PYA offers an HCC Periodic Checkup that employs computational data analytics to improve coding accuracy and appropriate reimbursement. Drawing on its extensive clinical background, PYA’s multidisciplinary team is able to assist large or small care environments by providing unbiased assessments of HCC accuracy without disrupting workflow. The team conducts education and training to show physicians and office staff ways to leverage best practices to ensure future coding accuracy improvement, as well as provides operational assessments, including electronic health records analysis.
For more information, please visit http://www.pyapc.com.
