This page addresses follow-up questions and additional information pertinent to our webinar
Unlocking HCC Codes and Clinical Documentation with a Twist.

** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q:  How can I improve my risk adjustment payments to ensure I can provide the most appropriate care to my chronically ill patients as well as my healthy ones?
A:  Improving your risk adjustment payments while ensuring quality care for both chronically ill and healthy patients is a balancing act between accurate documentation, proactive care management, and population health strategies. Leveraging a CDI specialists to review charts to ensure chronic conditions are documented and captured annually, supports the most specific code capture and ties the diagnosis to assessments and treatment plans is great way to improve risk adjustment payments. Educating providers on HCC coding and it impact on funding and patient care is equally as important to the documentation. Give them the why, not just the how.

Q:  Is there any consideration for disease interactions for risk adjustment payments?
A:  Yes — there is risk adjustment scoring for disease interactions, especially in the Medicare Advantage (MA) model and some other risk adjustment models like the HHS-HCC model used in ACA plans. These interactions are known as “disease interaction terms” or “interaction factors.” They recognize that certain combinations of conditions result in more complex, costly care than the sum of individual conditions alone.

Q:  If I suspect a patient has a condition, can I lead the provider in any way to get him to agree and diagnose the patient with what I suspect?
A:  No, per AHIMA all queries should be non-leading, support clinical validation, offer multiple reasonable options, and include an option to indicate clinically undetermined or not clinically relevant. Never provide only one option, suggest what you want them to say or leave of the no, uncertain, or not clinically relevant answer options.