5 Strategies for a Highly Effective HCC Coding Program

If you’re a physician group engaging in value-based care arrangements: coding and documentation accuracy should be your top priorities.

 
Inaction on your part will result in immediate loss of revenue and exposure to heavy audit penalties.

 
Whether you’re building a program from scratch or already have a program in place, the top five strategies for a successful program include:

 

Clinician Education — One-hour seminars or “codes of the month” emails don’t work.

Concurrent Chart Audits — This is more than checking boxes in the EMR to drag and drop chronic conditions into the progress note.

Point-of-care Clinical Guidance — Contrary to popular belief, we doctors don’t know everything! We make mistakes, and we don’t always have time.

Data Analytics — It’s painful and sometimes daunting, but it doesn’t have to be. Focus on a few critical points below to help drive an effective program.

Accountability — It’s a team effort. No single person should be held liable to be commended for the results.

 

Photo by RODNAE Productions from Pexels

 

Let’s dive deeper.

CLINICAL EDUCATION:

Clinicians, on average, retain 15% of any educational seminar you send them to after residency. Even with 15% knowledge retention, there is a consistent regression to the mean after eight weeks. Out of sight, out mind!

No one size fits all, but we know the Socratic method of teaching, consistent education, and regular feedback result in sustained behavior change amongst clinicians.

Socratic method —

Stop teaching at doctors and start objectively testing their knowledge. Try clinical vignettes in small group settings. Problem-based learning is how most medical education is practiced today, and yet, coding education has not caught up. Customize training to your clinician skill sets and practice patterns to improve buy-in.

 

Consistent education —

Training is done once a quarter or via email will consistently fall flat. Clinicians have a lot going on, and to cement, any new information must be presented to them multiple times and in various ways. This doesn’t have to be time-consuming but does need to remain consistent.

 

Regular feedback —

We, clinicians, don’t like to be wrong and always strive to be better. So customized feedback on documentation accuracy and opportunities for improvement are critical. Moving away from clinic-based or team-based results. Make sure each of your clinicians knows their strengths and weakness as it compares to the group.

 

Clinicians, on average, retain 15% of any educational seminar you send them to.

CONCURRENT CHART AUDITS:

This will assist you to impact in 2 ways: A) Ensure compliant documentation B) Adjudicating any claims submitted.

 

A typical clinical documentation improvement program ensures correction of over-and-under coding before billing. Typically institutions “hold” a bill for two business days to make any corrections. During this period, the provider can be asked to clarify inaccurate documentation and adjudicate the superbill to ensure proper 1:1 matching with progress notes to billable codes. Much of this is currently handled at the payor level for smaller physician groups.

 

As you start to take on more risk as a physician practice, you’ll need a consistent strategy across all your payor contracts. While vendors are currently using a heavily manual process, emerging technology from Doctus will help you do this at the point of care with our A.I. This will drop your OpEx, decrease your risk during RAD-V audits, and give you a more accurate line of sight to your risk scores.

 

POINT OF CARE CLINICAL SUPPORT:

Doctors were not trained as coders, and coders were not trained as doctors. The basic premise of accurate documentation is and should be clinical. Clinicians need to take better histories, perform more accurate physical exams, and synthesize data to make clinical diagnoses. No coder or AI can replace and find these diagnoses as the data is inherently flawed with significant gaps.

 

Doctus can help doctors ask better questions, perform accurate exams, and present clinical guidelines to lets doctors practice medicine. This will inherently improve your RAF accuracy and create physician buy-in better than any Natural Language Processing or A.I. alone. Unfortunately, EMRs are limited by their data sets. They operate only off the information inputted, so if your PCP doesn’t have the complete clinical picture from your hospital systems and your specialists inputted into the EMR, the clinical decision support in your EMR will be lacking.

 

Photo by energepic.com from Pexels

 

DATA ANALYTICS:

No pilot would fly a plane without an operational dashboard, so why do we allow the same for such a critical part of our value-based care business? No excuses, no delays. The ability to aggregate data from outside your EMR, deliver individual physician report cards on HCC documentation, and having visibility to patient annual wellness visits (AWVs) for everyone on the team is critical. If your team doesn’t have bandwidth, vendor it out. Time is critical, and the ROI is clear.

 

Remember, if the data is not easy to fetch and easy to understand, no one will use it. This does not need to be an expensive endeavor. Make sure you have visibility to the following data points by an individual physician.

 

    • Patient panel
    • Suspect vs. chronic diagnosis by patient
    • Complete vs. incomplete AWVs
    • % conditions addressed by a physician at each visit
    • Documentation accuracy

 

ACCOUNTABILITY:

Whether you plan to use a stick or a carrot approach to accurate documentation, the strategy needs to be intentional and meaningful. The entire team plays a role in an effective program, and accordingly, the strategies you deploy should touch each individual team member in a meaningful way. Rewards do not need to be financial, and the motivation here is it drives better clinical care. The emphasis in the following areas are compliant and effective:

    • Documentation accuracy
    • % AWVs scheduled
    • Regular engagement with any coding tools

 

DoctusTech’s proprietary A.I. can be embedded into your EMR or on your mobile phone to help you complete steps 1,2,3,4 very effectively. All you have to do is be ready to hold your team accountable.

Schedule a demo today & let us show you how.

— Doctus Team

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