You should know about risk adjustment and the renewed importance of HCC coding. Many risk-bearing providers’ financial health hinges on compliance with HCC coding directives. These directives are associated with Medicare Advantage and some Medicaid plans. However, during the pandemic, the Centers for Medicare and Medicaid Services issued changes. Providers were unable to appropriately judge the scope of these changes. As a result, they fail to fulfill new demands placed on them and keep up with the coding. This slowdown places an undue burden on the patients and tarnishes their experience. Plus, it extends the revenue cycle, harming the providers.
Risk Adjustment Coding Company
A risk adjustment coding company handles labeling patient files. The CMS established the HCC risk adjustment model to evaluate health risks. Individuals receive an RAF score depending on their overall health. Health conditions must be documented using ICD-10-CM standards. These standards link to HCC codes within the adjusted model from the CMS.
When patients receive higher RAF scores, doctors get more compensation. Since these patients require more care than others, it is a fair way to disburse funding. Nevertheless, the CMS resets the calendar for risk adjustment each year in January. Unless someone logs new codes for a patient, they will be considered to be healthy.
The CMS has a routine audit system where they check HCC code accuracy. If the documentation for a diagnosis is inadequate, reimbursement may be deficient. This documentation’s purpose is to catch all the chronic conditions suffered by patients.
Contact GeBBS Healthcare Solutions to know more.
