Help Carry the Real Weight of HCC Accuracy

Help Carry the Real Weight of HCC Accuracy

Proper documentation and coding are about more than just financial benefits.

There has been a lot of talk about the financial benefit in addressing hierarchical condition categories (HCCs) on an annual basis. I think it’s time we bring the conversation back to the epicenter. After all, proper HCC documentation and reimbursement does directly impact our most important factor: our patients.

Understand the Outcomes

For providers and other clinicians, it’s easy to see the actual patient outcomes on a regular basis; the rest of us (coders, billers, auditors, etc.) don’t have that advantage. The usual way for non-clinicians to understand outcomes is through hard data such as charts, graphs, numbers, time frames, etc. What we may not always be aware of, though, is what those numbers mean in a patient’s overall healthcare picture.

Connect the Dots to Better Patient Care

Did you know that the major components that go into ensuring accurate HCC documentation and coding also happen to be the major components that lead to the best patient outcomes? When we connect the dots of our everyday practices back to good patient care, it’s easy to see the connection.

A provider’s documentation of a patient’s past medical history (PMH) is crucial to knowing a patient’s complete, and sometimes complex, health status. This information helps clinicians to best understand a patient’s past and present medical needs, and it helps us achieve the most accurate coding (HCC or not).

Accurate and complete documentation at every visit and at every point during the visit (i.e., nurses rooming the patient, providers treating the patient, and front desk staff collecting and maintaining demographic and insurance information) helps maintain a pristine medical record. This creates an accurate representation of a patient’s disease burden, or health, and ensures all our patients are treated appropriately at every visit, no matter which provider they see.

Humanize the Codes

Bridging the gap between a human patient and an alphanumeric code system used for billing may be hard to visualize, but the patient benefit is real. When we use the right codes to depict rendered services, the clearest benefit is to the patient’s pocket. This is especially true with HCC coding. The more accurate the depiction of a patient’s health status, the more fully a Medicare Advantage (MA) plan will cover a patient’s necessary medical costs, reducing a patient’s out-of-pocket financial burden. When an MA plan doesn’t have a full picture, they are not able to plan correctly for a patient’s financial needs over time and may fall short of covering the cost for some of the sickest patients.

The financial trend continues over time. The better we represent a patient’s health status and disease burden now, the more accurately an MA plan will cover a patient’s medical needs year after year.

Understand the direct patient impact at every turn of the HCC initiative. If we continue to simply do what’s right for our patients, we will continue to see improved outcomes over time in the faces of our patients, as well as in our data.

Lara Carrion

Lara Carrion, CPC, CEMC, has more than 12 years of experience in medical billing, coding, auditing, and educating in various organizations across the country. She develops and facilitates training tools and electronic health record software for physician and coding staff at a large multi-state, multi-specialty healthcare organization. Carrion is a member of the Mooresville, N.C., local chapter, where she has previously served as president and vice president.

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