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What is HCC Coding
Charles Liang DO, Health Alliance Medical Director for the Carle Foundation Hospital, discusses the importance accurate HCC Coding and RAF and the latest parameters in the coding to help other providers and staff to assess patients quickly and provide the best care.
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Learn more about Charles Liang, DO
Charles Liang, DO
Charles Liang, DO is the Health Alliance Medical Director.Learn more about Charles Liang, DO
Transcription:
Melanie Cole, MS (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.
Welcome. Today we’re talking about the importance of accurate HCC coding, and the latest parameters in the coding to help other providers and staff assess patients quickly and provide the best care. My guest is Dr. Charles Liang, he’s the associate medical director for Health Alliance with the Carle Foundation Hospital. Dr. Liang, let’s just set the stage first about HCC coding. What is it?
Charles Liang DO (Guest): Well, HCC coding stands for hierarchical condition category. This is something that was invented by CMS. They started using this in 2004. Basically the whole reason for this is they wanted to assign a risk adjustment factor to patients so that they could measure how ill a patient is. This allowed health plans to rank their patients. The whole purpose of this is to prevent health plans from cherry picking patients. In other words, if you were a health plan that took care of the very sick and you could document it, then your compensation was greater than a health plan that just insured relatively healthy patients.
Host: Then expand a little for us, Dr. Liang, on the importance of accurate HCC coding and the risk adjustment factor. Compare apples to apples for us. How does this allow for your panel to do this?
Dr. Liang: Well an example I could think of is when a patient comes in with COPD and you chart that, that’s great. Sometimes what providers miss is they miss adding another diagnosis for example, chronic respiratory failure with hypoxia. So that’s an additional diagnosis that is probably accurate. For example, this would be with someone who’s on oxygen. That increases the risk adjustment factor by almost twice as much. So those are the kinds of things that we’re looking for. Another example would be a lot of times—and I've done this too as a provider—I’ll put diabetes unspecified because that’s easier to look for and that pops up right away when you do the diagnosis. But if you put diagnosis of diabetes with hyperglycemia, that almost triples the risk adjustment factor value. We’re looking for providers to bill more specifically and more accurately.
Host: So then be a little specific about how someone goes about documenting this as you're talking about adding things like diabetes and hyperglycemia and that that would change the coding. Tell us a little bit about the documentation itself and the acronym MEAT.
Dr. Liang: You know, the acronym MEAT, sometimes it can be confusing and a little bit overwhelming. So MEAT stands for monitor, evaluate, assess, and treat. When I first saw that slide and I first heard what it stood for, I was under the impression that I needed to have all the elements of meet. I needed to put down the monitoring, the evaluation, the assessment, and any treatments I was doing. Actually what MEAT means is you only need one of them. You only need one of the four listings. So for example, if I had a patient with atrial fibrillation—which is very common—I could say in my note that atrial fibrillation, patient is taking coumadin. That’s all I would need to say because that would show that the treatment is being done. Or I could say atrial fibrillation, patient is seeing cardiology. That would also work. I could say patient has atrial fibrillation, on coumadin, I'm gonna check NINR on this patient.
The big thing that we have to remember is this diagnosis and treatment that we’re documenting for follow up with these patients is the only way that we communicate with CMS. CMS really wants to know does this patient still have atrial fibrillation or not? It’s possible from last year the patient may have had an ablation and their atrial fib went away or they had a surgical procedure and it went away. They want to know does this patient still have atrial fib. We let them know yes they do by our diagnosis and the coding for atrial fibrillation. We need to support that in our documentation with the MEAT concept, and, again, you only need one of these to put down.
A big issue that a lot of providers have—and I total understand this—is a patient comes in for a cold. The provider tells me well I can't diagnose atrial fibrillation because I didn’t really review their atrial fibrillation symptoms. I didn’t check their heart. I didn’t listen to their heart. I didn’t ask them if they were having palpitations. But in the assessment, you can still put atrial fibrillation as long as you don’t up code. The purpose of listing atrial fibrillation in the diagnosis is not to make this into a 99214 from a 99213. The purpose of putting it into the assessment is just our way of communicating to CMS that this patient, indeed, still has atrial fibrillation.
Host: Wow. So must an acceptable problem list show the evaluation and treatment for each condition that it relates on the ICD code. So you have to absolutely list out each condition as it’s coded.
Dr. Liang: Yes, but we help you with that. At Carle, we now have a best practice alert that’s going to be coming very soon right on the chart. When you open the chart, you can see the best practice alert over on the left on the story book function of Epic. When you click that, that will tell you the diagnosis that need to be updated. If someone else updated atrial fibrillation in the chart already, then you don’t have to do it and it won't show up. These diagnoses only have to be updated once per calendar year. So the flipside to that is January 1st when you see these patients, they're gonna have a lot of HCC codes that need to be updated. December 20th, hopefully they won't have any because by then they’ll be seen enough and often enough to have these codes updated. I just want to stress again that this is an important service we’re providing to the patients. CMS compensates our group based on how ill the patients are, and we need that revenue in order to properly take care of our patients.
Host: Well that’s certainly true. So what do you feel are some of the more important barriers to this coding?
Dr. Liang: Well a lot of the barriers are providers don’t feel that they have enough time to do this documentation. They don’t feel like it’s pertinent because that’s not what the patient came in for. They’re here for an ankle sprain. Why am I documenting that they're still taking insulin for diabetes? So what we need is a cultural change to where providers understand that we are a vertically integrated network at Carle. What Medicare Advantage does indirectly effects how we all do as a group. Documenting how ill patients are helps the patient because it reflected in the problem list, and when the next time someone else not you looks at the chart, they can better appreciate what’s happening with the patient’s history.
Host: Well it’s more comprehensive then isn’t it?
Dr. Liang: And it’s more accurate.
Host: It is more accurate. So give us a summary of the HCC coding as you would like other providers to understand care gaps or the way that it is going to be in the coming future.
Dr. Liang: Doing HCC codes accurately helps the patient by documenting it on the problem list so you and see it and nursing staff can see it, other providers can visualize it quickly. It also helps the organization because we are compensated from CMS directly based on how ill patients are. The only way CMS knows how ill patients are is through the HCC coding.
I would like to address the often heard complaint that I don’t have time for this. I guess I would come back and say that when you're documenting in the chart, it takes a long time sometimes to document everything that you've done during the exam. We need to think of HCC coding documentation as just like it—It’s just like when you document things in the chart. This is part of the documentation. You would never skip the heart exam because you felt like you didn’t have time. “Well I listened to the heart, but I'm not gonna document it because I don’t have time.” No one would ever do that. So what we need is a cultural change where we view HCC coding documentation the same as we view any other documentation, and that is it’s very important, it’s very crucial. If it isn’t documented, then it didn’t happen.
Host: Wow. What a great segment and so informative. Thank you so much Dr. Liang for coming on with us today. That wraps up this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, head on over to our website at carleconnect.com for more information and to get connected with one of our providers. We hope the information gained will be applicable to your work and life. If you found this podcast as informative and interesting as I did, please share with other providers. Share on your social media and be sure not to miss all the other fascinating podcasts in our library. Until next time I'm Melanie Cole.
Melanie Cole, MS (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.
Welcome. Today we’re talking about the importance of accurate HCC coding, and the latest parameters in the coding to help other providers and staff assess patients quickly and provide the best care. My guest is Dr. Charles Liang, he’s the associate medical director for Health Alliance with the Carle Foundation Hospital. Dr. Liang, let’s just set the stage first about HCC coding. What is it?
Charles Liang DO (Guest): Well, HCC coding stands for hierarchical condition category. This is something that was invented by CMS. They started using this in 2004. Basically the whole reason for this is they wanted to assign a risk adjustment factor to patients so that they could measure how ill a patient is. This allowed health plans to rank their patients. The whole purpose of this is to prevent health plans from cherry picking patients. In other words, if you were a health plan that took care of the very sick and you could document it, then your compensation was greater than a health plan that just insured relatively healthy patients.
Host: Then expand a little for us, Dr. Liang, on the importance of accurate HCC coding and the risk adjustment factor. Compare apples to apples for us. How does this allow for your panel to do this?
Dr. Liang: Well an example I could think of is when a patient comes in with COPD and you chart that, that’s great. Sometimes what providers miss is they miss adding another diagnosis for example, chronic respiratory failure with hypoxia. So that’s an additional diagnosis that is probably accurate. For example, this would be with someone who’s on oxygen. That increases the risk adjustment factor by almost twice as much. So those are the kinds of things that we’re looking for. Another example would be a lot of times—and I've done this too as a provider—I’ll put diabetes unspecified because that’s easier to look for and that pops up right away when you do the diagnosis. But if you put diagnosis of diabetes with hyperglycemia, that almost triples the risk adjustment factor value. We’re looking for providers to bill more specifically and more accurately.
Host: So then be a little specific about how someone goes about documenting this as you're talking about adding things like diabetes and hyperglycemia and that that would change the coding. Tell us a little bit about the documentation itself and the acronym MEAT.
Dr. Liang: You know, the acronym MEAT, sometimes it can be confusing and a little bit overwhelming. So MEAT stands for monitor, evaluate, assess, and treat. When I first saw that slide and I first heard what it stood for, I was under the impression that I needed to have all the elements of meet. I needed to put down the monitoring, the evaluation, the assessment, and any treatments I was doing. Actually what MEAT means is you only need one of them. You only need one of the four listings. So for example, if I had a patient with atrial fibrillation—which is very common—I could say in my note that atrial fibrillation, patient is taking coumadin. That’s all I would need to say because that would show that the treatment is being done. Or I could say atrial fibrillation, patient is seeing cardiology. That would also work. I could say patient has atrial fibrillation, on coumadin, I'm gonna check NINR on this patient.
The big thing that we have to remember is this diagnosis and treatment that we’re documenting for follow up with these patients is the only way that we communicate with CMS. CMS really wants to know does this patient still have atrial fibrillation or not? It’s possible from last year the patient may have had an ablation and their atrial fib went away or they had a surgical procedure and it went away. They want to know does this patient still have atrial fib. We let them know yes they do by our diagnosis and the coding for atrial fibrillation. We need to support that in our documentation with the MEAT concept, and, again, you only need one of these to put down.
A big issue that a lot of providers have—and I total understand this—is a patient comes in for a cold. The provider tells me well I can't diagnose atrial fibrillation because I didn’t really review their atrial fibrillation symptoms. I didn’t check their heart. I didn’t listen to their heart. I didn’t ask them if they were having palpitations. But in the assessment, you can still put atrial fibrillation as long as you don’t up code. The purpose of listing atrial fibrillation in the diagnosis is not to make this into a 99214 from a 99213. The purpose of putting it into the assessment is just our way of communicating to CMS that this patient, indeed, still has atrial fibrillation.
Host: Wow. So must an acceptable problem list show the evaluation and treatment for each condition that it relates on the ICD code. So you have to absolutely list out each condition as it’s coded.
Dr. Liang: Yes, but we help you with that. At Carle, we now have a best practice alert that’s going to be coming very soon right on the chart. When you open the chart, you can see the best practice alert over on the left on the story book function of Epic. When you click that, that will tell you the diagnosis that need to be updated. If someone else updated atrial fibrillation in the chart already, then you don’t have to do it and it won't show up. These diagnoses only have to be updated once per calendar year. So the flipside to that is January 1st when you see these patients, they're gonna have a lot of HCC codes that need to be updated. December 20th, hopefully they won't have any because by then they’ll be seen enough and often enough to have these codes updated. I just want to stress again that this is an important service we’re providing to the patients. CMS compensates our group based on how ill the patients are, and we need that revenue in order to properly take care of our patients.
Host: Well that’s certainly true. So what do you feel are some of the more important barriers to this coding?
Dr. Liang: Well a lot of the barriers are providers don’t feel that they have enough time to do this documentation. They don’t feel like it’s pertinent because that’s not what the patient came in for. They’re here for an ankle sprain. Why am I documenting that they're still taking insulin for diabetes? So what we need is a cultural change to where providers understand that we are a vertically integrated network at Carle. What Medicare Advantage does indirectly effects how we all do as a group. Documenting how ill patients are helps the patient because it reflected in the problem list, and when the next time someone else not you looks at the chart, they can better appreciate what’s happening with the patient’s history.
Host: Well it’s more comprehensive then isn’t it?
Dr. Liang: And it’s more accurate.
Host: It is more accurate. So give us a summary of the HCC coding as you would like other providers to understand care gaps or the way that it is going to be in the coming future.
Dr. Liang: Doing HCC codes accurately helps the patient by documenting it on the problem list so you and see it and nursing staff can see it, other providers can visualize it quickly. It also helps the organization because we are compensated from CMS directly based on how ill patients are. The only way CMS knows how ill patients are is through the HCC coding.
I would like to address the often heard complaint that I don’t have time for this. I guess I would come back and say that when you're documenting in the chart, it takes a long time sometimes to document everything that you've done during the exam. We need to think of HCC coding documentation as just like it—It’s just like when you document things in the chart. This is part of the documentation. You would never skip the heart exam because you felt like you didn’t have time. “Well I listened to the heart, but I'm not gonna document it because I don’t have time.” No one would ever do that. So what we need is a cultural change where we view HCC coding documentation the same as we view any other documentation, and that is it’s very important, it’s very crucial. If it isn’t documented, then it didn’t happen.
Host: Wow. What a great segment and so informative. Thank you so much Dr. Liang for coming on with us today. That wraps up this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, head on over to our website at carleconnect.com for more information and to get connected with one of our providers. We hope the information gained will be applicable to your work and life. If you found this podcast as informative and interesting as I did, please share with other providers. Share on your social media and be sure not to miss all the other fascinating podcasts in our library. Until next time I'm Melanie Cole.