Capturing HCC Opportunities with Decreased Patient Volumes
Like many people across the nation in 2020, maintaining social distancing and avoiding unnecessary risk has led individuals to postpone their typical physician services due to COVID-19. Practices have reported a 50% average decrease in patient volume, with a vast majority of canceled appointments not being rescheduled. Not only do cancellations mean patients are missing out on important care, it results in reduced claims and diagnoses, and therefore, fewer opportunities to identify and document HCC conditions that could impact RAF scores.
According to CMS’ Office of the Actuary, healthcare spending is predicted to increase at an average annual rate of 5.5%, reaching $6 trillion by 2027. This projected growth doesn’t account for reduced claims and diagnoses or the impact of COVID-19 on payer risk scores.
With the decreases related to in-person encounters, and as Medicare Telehealth surges with COVID-19, it has never been more essential for health systems and practices to ensure that all appropriate patient HCC codes are fully captured. However, with staff burnout and the continued uncertainty of the pandemic, implementing new strategies is no easy task.
When care for at-risk members becomes irregular, as it has been during the pandemic, healthplans face additional obstacles dealing with and closing HCC coding and quality gaps. This, of course, has a direct impact on the overall health and wellness of the plan’s members. Under-documented diagnoses lead to deteriorating conditions that distort the patient profile and adversely affect reimbursement for the care and management of chronic conditions like diabetes. For example, the absence of annual risk assessments make identifying changes in member risk profiles very difficult, that in turn impacts the ability to ensure the proper services are provided. Changes in the traditional cadence of patient provider interactions reduces the ability to achieve accurate and complete disease discovery and diagnoses, thereby negatively impacting health plan payments from CMS that appropriately reflect the risk profile of complex populations.
With the uncertainty as to when the COVID-19 pandemic may end, organizations need to focus on risk adjustment optimization strategies that ensure quality gap closure and mitigate potential risk score deficits for 2020 service dates. The most successful healthcare organizations are those that can quickly adapt and find new beneficial technology solutions. The abnormal adversities brought on by a public health emergency, combined with the evolution to value-based care, represents why health plans must remain insightful in their approaches to exploring new innovative healthcare technology.
HCC coding is not intuitive, but accurate HCC coding is necessary to receive fair compensation. The integration of risk adjustment software with electronic health record systems can be extremely effective for capturing every appropriate HCC. ForeSee Medical’s specialized risk adjustment software platform collects available patient data, and using artificial intelligence and medical algorithms, detects HCC related diseases from patient charts and suggests ICD codes that perfect RAF Medicare payments.
With the number of claims per person and the number of diagnoses declining significantly throughout 2020 due to COVID-19, healthcare organizations need to improve coding productivity standards prospectively before a claim is sent. Medicare risk adjustment software with clinical decision support at the point of care makes it easier to close HCC and HEDIS gaps, thereby reducing workload on office staff.
Do you want to increase the profitability of your Medicare risk contracts? Do your physicians get decision support related to patient disease burden at the point of care? Perfect your RAF scores and improve HCC coding productivity with A.I. powered software from ForeSee Medical.
Blog by: The ForeSee Medical Team