Research estimates that healthcare practices lose up to 30% of revenue to coding errors. But many still struggle to ensure providers prioritize coding and submit accurate and comprehensive risk adjustment data.
HCC coding technology offers a solution to this problem and poses clear benefits for both practices and providers. By unlocking provider incentives and reducing the burden of coding, it can help your organization increase risk adjustment factor (RAF) scores by 35% on average – all while making life easier for your providers.
Every healthcare practice that accepts Medicare Advantage (MA) patients relies on hierarchical condition category (HCC) coding to enable risk adjustment and receive fair reimbursement for the care they offer. But most organizations struggle to submit comprehensive coding that is backed up by reliable documentation.
The problem is individual providers often find coding difficult and time-consuming. It takes their attention away from patient care, often taking up several hours every week. Given that physicians already spend around one-third of their time generating clinical documentation, HCC coding only adds to the immense administrative burden.
This results in problems for both providers and practices:
Many organizations combat these trends with explicit incentives to encourage providers to take more time over their HCC coding. Nearly 20% of primary care physicians (PCPs) are compensated in part based on their HCC coding, while 6.5% are paid based on the accuracy of their coding. But this leaves several problems unresolved:
These problems require a different approach to coding – and new technology answers that requirement.
Rather than revising coding incentives or creating extra demands on physicians’ time, forward-thinking practices can create a win-win scenario for providers. HCC coding tools help remove barriers to accurate and complete submissions:
These tools leverage natural-language processing (NLP) to ingest all clinical data – both structured and unstructured – and use sophisticated rules to identify relevant HCC codes. These codes are presented as recommendations at the point of care, enabling providers to quickly evaluate and select the ones that are correct. This eliminates nearly all manual effort and frees providers to focus on patient care.
Because coding recommendations are based on data existing within the system – and pull information from a comprehensive range of sources – codes are backed up by accurate and easily accessible documentation. This reduces risk for payers and avoids the back-and-forth process of verifying and proving diagnoses during risk adjustment.
Through seamless integration within the EHR, these tools also make it easier to measure and tie providers’ performance to coding incentives. Practices can accurately compensate providers for their coding efforts – while actually reducing the administrative burden significantly.
Inferscience delivers a comprehensive suite of HCC coding tools to improve provider incentives and ensure optimal reimbursements for MA patients. Our software enables you to:
All of which enables the average provider to increase their RAF scores by 35%.
Want to explore how our solutions could improve risk adjustment at your organization?
