Specificity in documentation is extremely important for HCC coding as it determines if the diagnosis is an HCC or not and also the category to which the diagnosis is assigned. A patient’s risk adjustment factor (RAF) score is reset to zero every January 1, so it’s essential to document and code HCC diagnoses yearly to reflect accurate health status. Another essentiality of the risk adjustment model is the capturing of patients’ chronic conditions through documentation and coding every year. Ensuring an accurate problem list involves removing duplicative and inactive diagnoses and helps identify key areas for the assignment of HCC codes and RAF values. EMRs have been full of data being put in by healthcare organizations for years, resulting in a lot of data, and most likely an inaccurate problem list. There are certain concepts to be followed for the HCC risk adjustment model, and having an accurate problem list is one of them. Reporting a complete picture of the risk adjustment factor increases the accuracy of the patient score and ideally reduces the need to request medical records or audit providers’ claims. According to the ‘American Academy of Family Physicians, “hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient,” helping to appropriately measure quality and cost performance. Healthy patients have a below-average RAF score so revenue from the insurance premium is transferred from healthy patients to patients with an above-average RAF score. The HCC model assigns a Risk Adjustment Factor (RAF) score to each patient basis patient’s demographics and diagnoses, which is a relative measure of how costly that patient is anticipated to be. This article walks through the basics of the risk adjustment model and how the provider can ensure accuracy in documentation and HCC coding to achieve swift and maximal reimbursements. With the rising number of beneficiaries enrolled in Health insurance Advantage plans, it’s more important than ever for healthcare organizations to pay attention to this model and make sure physicians are coding diagnoses appropriately to ensure fair compensation. Inaccurate HCC coding not only affects the patients and payers but also has an impact on healthcare organizations’ reimbursement. Register for the 2021 Southeastern Health Data and Information Conference here.The Hierarchical Condition Category (HCC) risk adjustment model is an integral element within the medical coding world. Find out more information by reviewing the event’s agenda here.įor more information regarding MEAT Criteria and the HCC risk adjustment process, review our article “ HCC Chronic Conditions and MEAT Criteria.” The presentation will be held in the Hilton Ballroom West ABC from 1 – 1:45 pm Eastern. The presentation also analyzes sample clinical scenarios, and Risk Adjustment Factor and HCC calculations to aid medical coders and billers. This will include detailed examples of chronic condition documentation. Applying the MEAT Criteria discussed during the presentation, attendees will practice applying the formula in real-time. They will learn what experts consider to be acceptable and unacceptable sources of data. Attendees will explore various examples of Risk Adjustment documentation. Then, she will walk through the structure of the CMS-HCC Risk Adjustment model and compare it to that of the HHS-HCC model. She will also cover the principles of Risk Adjustment for Medicare Advantage. During her Quad21 presentation, Karen will educate attendees on the methodology of Risk Adjustment. During Risk Adjustment documentation and coding, coders use the MEAT formula to help them correctly identify and assign HCC chronic condition diagnoses. The presentation will focus on the required documentation for MEAT Criteria coding. The theme for the event, which is conducting in-person presentations and exhibits this year, is “HIM: Infinite Possibilities.”ĭoes Your Documentation Meet the MEAT Criteria? By Karen Youmans, MPA, RHIA, CCS The 2021 Southeastern Health Data and Information Conference will be held at the Hilton Myrtle Beach Resort, 10000 Beach Club Dr, Myrtle Beach, SC, on October 21 – 24, 2021. YES is excited to announce YES President and CEO Karen Youmans will be educating attendees on the MEAT Criteria coding and documentation practices at the 2021 Southeastern Health Data and Information Conference (Quad21).
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