A medical billing system is only as strong as its coding system. But as the number of Medicare Advantage (MA) enrolees rises, so does the complexity of risk adjustment – the process through which HCC codes are used to calculate reimbursement rates.
This article explains how the right HCC coding software can streamline and simplify risk adjustment. Not only will this improve risk scores and drive more income, but it will also reduce the burden on clinicians and give them more time to focus on patient care.
But first, let’s establish exactly why providers should care about HCC coding accuracy and quality.
HCC coding is the foundation of Medicare Advantage reimbursements:
The takeaway is simple: providers must submit all relevant HCC codes for every MA patient – along with comprehensive documentation – if they want to receive full compensation for their services. Errors can lead to both the practice and individual providers losing out on payments they’ve earned. And given that physicians’ Medicare pay rates have dropped 33% over 20 years, such errors should be a major priority.
So why do we continue to see a high percentage of coding errors?
The truth is risk adjustment is a distracting burden for most providers. They want to focus on helping patients, and HCC coding is experienced as a barrier to that task – especially when the volume of administrative tasks grows and documentation is complicated by confusing, often fragmented IT systems.
It can also be challenging to keep up with the changing volume of coding if HCC coding is limited to a small in-house staff. Medical coders are expected to stay on top of changes in coding standards, rules, and guidelines; providers are not professional coders and don’t get the opportunity to regularly study updates or coding best practices.
Ultimately, handling coding manually requires a significant amount of time, money, and effort. This is especially true as the number of clients grows and the need for efficiency and reduced workload grows.
The results are clear:
The solution, however, is not to place a heavier emphasis on HCC coding. Many providers are already offered compensation incentives to focus on HCC coding; they simply don’t have the time to spend searching complicated lists to ensure every condition is meticulously coded and documented.
A proven, automated system can be used by healthcare providers in order to improve risk scores and income while reducing the burden on clinicians. Automated coding support reduces the burden on doctors by integrating the EHR and revealing any coding gaps that may exist; it can also continuously improve the accuracy and optimization of coding across distinct and differentiated network contracts using machine-learning algorithms.
Here are three more ways HCC Coding Software improves risk adjustment workflows and gives providers, payers, and patients are better deal:
The cost of hiring medical coders is high. There is a shortage of medical coders at the moment. As a result of the ICD-10, coders had to master the new system. Due to ICD 10’s deployment, many medical coders will be forced to retire as their average age reaches 54 in the near future.
It is far more difficult to find qualified coders for specialty-specific coding. Depending on where you live, you may not be able to find medical coders that meet your demands. Even though qualified medical coders are scarce, their earnings are rising because of it. Programmers today have a plethora of professional paths to choose from, making it tough to keep them around. According to the AAPC, the average annual salary for a medical coder is $52,411. A higher salary is expected of certified coders and those with extensive experience. Outpatient documentation experts and physician practice managers make an average annual salary of $64,000 as certified coding specialists.
As a result of erroneous procedures and/or code faults, there could be additional fines and regulatory fees.
Thus, the necessity for a ‘low cost, high benefit, and high reward’ system must be implemented in order to improve this process. With a small number of medical coders and efficient overall management, coding software could be used more effectively.
Every insurance company has its own set of coding guidelines that must be followed to ensure “clean claims,” and when these guidelines change, the likelihood of a claim being rejected increases. Rejected claims cause your revenue cycle to slow down and your team to spend more time submitting claims, all of which has a negative impact on your cash flow. It is difficult or impossible for most medical practices to devote additional resources to increasing the percentage of billed charges that are collected. The money you should have received for services you supplied could be lost if a claim is denied because of a small error in the paperwork.
Your revenue cycle might be severely impacted by mistakes. Ideally, your team can immediately detect an error in a rejected claim and resubmit it, recouping most or all of the revenue. As a result, you may have to write off the claim as bad debt because your staff either doesn’t have time or doesn’t know what the problem is.
Before a claim is sent out, it can be automatically checked using the software. Claim data is compared to the most recent industry standards (such as LCD and NCD modifications), small inaccuracies in patient data or codes are checked, and the claim is subject to payer-specific guidelines.
With automated ICD-10 coding, both the present visit and pertinent clinical history of a patient can be taken into account for more precise coding. At the point of care, codes are correctly detected and inputed, resulting in prompt and accurate compensation. Providers and employees save time and money by not having to go back and fix errors that were made in the first place.
Also, At the point of care, the use of technology enables providers to identify the relevant codes for a patient’s visit. As a result, physicians don’t have to interrupt the care process or wait until the end of a long day to finish coding and close the charts. As soon as the visit is ended, providers are certain that all paperwork and coding is completed.
Medical coders must keep up with the current standards and coding clinics as they are revised. When assigning codes, the suggested auto-coding method will take the most recent coding clinics and guidelines into account, making it easier to stay in compliance.
The extent to which auto coding improves documentation is another key part of compliance. Medical records will be able to identify any missing information thanks to this method. Errors or anomalies can be instantly flagged, tracked, and reminders sent to physicians so that they can fix the gaps. It can also have a substantial impact on the improvement of clinical documentation (CDI). Complications and comorbidities will be better documented if the solution identifies potential holes in the overall CDI process.
AI-assisted auto-coding will cut down on the amount of time coders need to spend reviewing medical records, extracting diagnoses and procedures performed, and then producing accurate findings.
There will be an increased focus on a machine-first delivery paradigm, and coders will be able to manage flagged or complex coding in both inpatient and outpatient settings with more proficiency when the confidence score of auto-coding solutions increases Coders’ abilities and performance will be enhanced as a result of this. Increased facility revenues, lower denial rates, and less reliance on coders are all benefits of accurate and precise coding.
HCC coding software can be complicated to source, evaluate, and integrate – and that’s why we built HCC Assistant.
Our software uses natural language processing (NLP) to ingest structured and unstructured data. With this centralized view of each patient’s medical history, the tool instantly identifies relevant HCC codes and recommends them at the point of care – with a 97% accuracy rate.
This frees providers to focus on patient care and simply accept or reject coding in seconds – boosting coding accuracy, documentation quality, and patient care. The average user not only saves hours of manual effort but increases their RAF scores by an average of 35%.
Want to see how it could help empower your providers and improve your risk adjustment workflows?
REFERENCES
https://www.healthaffairs.org/do/10.1377/forefront.20210927.6239/
https://www.aapc.com/resources/research/medical-coding-salary-survey/
https://archive.cdc.gov/#/details?url=https://www.cdc.gov/nchs/icd/icd10cm_pcs_background.htm
HEALTH INSURANCE CLAIM FORM – CDC
