![]() ![]() The reporting requirements include the following: Having thorough knowledge of CMS guidelines and reporting requirements will assist in complete documentation and accurate code assignment, preventing payment recovery. The findings may be extrapolated, resulting in significant payment recovery, so it is important to constantly monitor quality in order to prevent potential penalties. It is important to know that CMS performs annual targeted audits to validate HCCs, and will calculate each contract’s payment error based on the results. External causes not being documented clearly or being omitted.Īs experience has taught us, once a code is directly linked to reimbursement, it becomes subject to validation audits and retraction.Internal claims system not able to report/store all codes (Number limited).Keeping up with coding changes and reporting codes accurately.Specialist lacking documentation of chronic conditions that are outside their specialty.Missing documentation for morbid obesity (E66.01) and associated BMI over 40 (Z68.41-45).Diabetic manifestations and/or complications not documented and/or linked.Chronic conditions not documented annually (The HCC system is prospective and uses patients’ diagnoses from one year to calculate reimbursement for the next year).Status of malignancy not clearly described (Current, history of, or in remission).Highest degree of specificity, including acuity, not documented (Major depression vs.Missing documentation to support reporting of factors influencing health status and contact with health services Z00 – Z99 (e.g.We are able to identify areas of concern and make recommendations for improvement in documentation and coding practices.īelow are the top ten coding pitfalls to be aware of related to the identification of HCCs: UASI performs HCC coding, auditing, CDI and education for clients to ensure compliant practices and appropriate reimbursement. Specified heart arrhythmias, including atrial fibrillation.Diabetes with manifestation and/or complications.Therefore, it is critical to physician practices’ financial viability to invest resources into ensuring chronic conditions are being documented and coded comprehensively, according to CMS guidelines.īelow is an example of prevalent, often missed HCCs: ![]() If the coding is accurate, reimbursement from CMS or other payers utilizing HCCs is then accurate based on the patients’ severity of illness.Īs such, reimbursement can be negatively impacted for an entire fiscal year without thorough documentation and coding. As demographics typically remain the same, it is the physicians’ documentation and accurate code assignment in which they can have the greatest impact on future reimbursement. In the risk factor model, reimbursement is calculated annually based on the patient’s demographics and their chronic conditions (HCCs). Payments were thus driven by CPT codes and their relative value. In the historical fee-for-service model, reimbursement was based on the services physicians provided. Now, physicians will be compensated based on the estimated health cost according to risk profiles, as opposed to the prior fee-for-service methodology they are familiar with. However, with their increased impact on professional fee reimbursement due to the implementation of MACRA, HCCs have become a hot topic and, therefore, a focus point in every coding arena. Hear tips for documenting encounters to ensure the MEAT criteria is met.Hierarchical Condition Categories (HCCs) have been around since 2004.Discover the alternative “TAMPER” criteria a coder can use to determine if a diagnosis is current.Learn the importance of accurate documentation and the risk of non-compliance.Please join us for the webinar as we walk through the M.E.A.T criteria and learn how to apply the criteria in your code assignment. Most organizations use the “M.E.A.T.” criteria: Monitoring, Evaluation, Assessment, Treatment for their documentation practices, as well as HCC assignments and ICD-10-CM diagnosis coding. This means that diagnoses cannot be completely determined from test results and a patient’s past medical history. Physicians must precisely document each patient diagnosis and the diagnosis must be based on clinical medical record documentation from a face-to-face encounter. ICD-10-CM Coding Guidelines state that we code all documented conditions that coexist at the time of the encounter and require or affect patient care treatment or management. ![]()
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