5 Strategies for a Highly Effective HCC Coding Program

You need 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, and failure to act can lead to lost revenue and significant audit penalties. And 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 — Clinicians work under time constraints and manage complex cases, making it challenging to recall every diagnosis and guideline. Reliable clinical support helps ensure accurate documentation without adding to their workload.
    

 

• • Data Analytics — While data analytics can seem overwhelming, it doesn’t have to be. Concentrating on a few key areas can drive a more effective program.
    

 

• • Accountability —Achieving coding accuracy is a team effort. No single person should be held liable to be commended for the results.

 

 

Let’s dive deeper into your HCC Coding Program.

CLINICAL EDUCATION FOR YOUR HCC CODING PROGRAM

Clinicians, on average, retain 15% of any educational seminar they attend 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 among 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, 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 it does need to remain consistent.

 

Regular feedback

Clinicians always strive to be better. So, customized feedback on documentation accuracy and opportunities for improvement are critical. Rather than focusing only on clinic-based or team-based results, ensure each clinician understands their individual strengths and weaknesses compared to the group.

 

Clinicians, on average, retain 15% of any educational seminar they attend residency.

CONCURRENT CHART AUDITS

This will help in two ways: a) ensuring compliant documentation and b) adjudicating claims before submission.

A typical clinical documentation improvement program ensures that over- and under-coding are corrected 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 with your practice, you’ll need a consistent strategy across all your payor contracts. While vendors are currently using a heavily manual process, emerging technology from DoctusTech 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 IN YOUR HCC CODING PROGRAM

 

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 and has significant gaps.

 

DoctusTech helps clinicians ask more insightful questions, conduct thorough exams, and access clinical guidelines to let them take care of their patients. This will inherently improve your RAF accuracy and create physician buy-in better than any other product. 

 

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.

 

 

 

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 have visibility to patient annual wellness visits (AWVs) for everyone on the team is critical. If your team doesn’t have the bandwidth, outsource it. 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.

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 AI can be embedded into your EMR or on your phone to help you effectively complete steps 1, 2, 3, and 4. All you have to do is be ready to hold your team accountable.

 

Want to see how DoctusTech can streamline your HCC Coding Program? Schedule a demo today!

 

 

What are the key strategies for building an effective HCC coding program?

The key strategies for an effective HCC coding program include clinician education, concurrent chart audits, point-of-care clinical guidance, data analytics, and accountability. Each plan is crucial in improving documentation accuracy, ensuring compliance, and optimizing risk adjustment factor (RAF) scores in value-based care settings.

How can clinician education improve HCC coding accuracy?

Clinician education improves HCC coding accuracy using the Socratic method, consistent training, and regular feedback. Personalized training sessions and ongoing education help clinicians retain crucial coding knowledge, leading to better documentation and reduced errors. Regular feedback ensures continuous improvement in coding accuracy.

Why are concurrent chart audits essential for HCC documentation compliance?

Concurrent chart audits are essential because they ensure that documentation matches billable codes and complies with coding guidelines before submission. By conducting audits during documentation, physician groups can identify and correct errors in real time, reducing the risk of audit penalties and improving reimbursement accuracy.

How can point-of-care clinical guidance enhance RAF accuracy in value-based care?

Point-of-care clinical guidance enhances RAF accuracy by giving clinicians real-time access to relevant clinical data and guidelines. This guidance helps clinicians make more accurate diagnoses and document conditions correctly, ensuring that all relevant chronic conditions are captured and improving the overall risk adjustment score.

What data analytics metrics should physician groups track for successful HCC coding?

Physician groups should track several key data analytics metrics to ensure successful HCC coding, including patient panel data, suspect vs. chronic diagnoses, the completion of annual wellness visits (AWVs), and documentation accuracy. Tracking these metrics enables better insight into coding performance and helps identify areas for improvement in documentation practices.