HCC Coding – Top 5 Tips to Increase the Practice Revenue

With several changes taking place in the Medicare Advantage industry, it has become extremely important for physicians to capture data in a timely and accurate manner. It has become more critical than ever for them to also track a patient’s care and condition over a period of time. If any provider fails to do so, it will become difficult for their practice to remain profitable or survive in business. Especially providers who are looking after patients enrolled in the Medicare managed care plans need to be careful. They will have to remain prepared for reductions in revenue. Without adapting to the new environment and changes, they will continue to lose significant dollars in revenue.

What is the best solution that they can take up to avoid revenue challenges?

The answer is focus on HCC coding (Hierarchical Condition Category coding). The HCC model is used by Medicare for calculating payments to providers and health plans. But unfortunately, most Medicare Advantage plans and physicians aligned to these plans continue to miss out on opportunities to improve their revenue potential. Can this be changed?

Here are five ways in which physicians can increase practice revenue with focus on HCC coding:

1. As an independent practice association or a medical group, physicians are most likely to send data to contracted health plans in an electronic manner. If they use EDI (Electronic Data Interchange) vendor for this task, they must speak to them to ensure that the vendor sends them reports on rejected items. They must ask them to verify the number of diagnosis codes they are capturing and transmitting to health plans.
2. It is necessary for physicians to find out if new patients have already assigned HCCs from their prior health plan. If yes, then they must ensure that those are being maintained, moving forward. This will help them maintain continuity of care and data collection.
3. Chart reviews need to be done regularly. If the reviews uncover documentation errors, then training guides should be developed to solve this issue. Even one-on-one training with office staff and physicians need to be conducted.
4. Member’s conditions need to be documented and assessed every year. This is what CMS expects from physicians. It is necessary to monitor each member’s HCCs for ensuring consistency in reporting.
5. As new diagnosis codes get added or old ones get deleted every year, physicians must work with an updated codebook.