With
several changes taking place in the Medicare Advantage industry, it has become
extremely important for physicians
to capture data in a timely and accurate manner. It has become more critical
than ever for them to also track a patient’s care and condition over a period
of time. If any provider fails to do so, it will become difficult for their
practice to remain profitable or survive in business. Especially providers who
are looking after patients enrolled in the Medicare managed care plans need to
be careful. They will have to remain prepared for reductions in revenue.
Without adapting to the new environment and changes, they will continue to lose
significant dollars in revenue.
What is the best solution
that they can take up to avoid revenue challenges?
The
answer is focus on HCC
coding (Hierarchal Condition Category coding). The HCC model is used by
Medicare for calculating payments to providers and health plans. But
unfortunately, most Medicare Advantage plans and physicians aligned to these
plans continue to miss out on opportunities to improve their revenue
potential. Can this be changed?
Here are five ways in which
physicians can increase practice revenue with focus on HCC coding:
1.
As an independent practice association or a
medical group, physicians are most likely to send data to contracted health
plans in an electronic manner. If they use EDI (Electronic Data Interchange)
vendor for this task, they must speak to them to ensure that the vendor sends
them reports on rejected items. They must ask them to verify the number of
diagnosis codes they are capturing and transmitting to health plans.
2.
It is necessary for physicians to find out if
new patients have already assigned HCCs from their prior health plan. If yes,
then they must ensure that those are being maintained, moving forward. This
will help them maintain continuity of care and data collection.
3.
Chart reviews need to be done regularly. If the
reviews uncover documentation errors, then training guides should be developed
to solve this issue. Even one-on-one training with office staff and physicians
need to be conducted.
4.
Member’s conditions need to be documented and
assessed every year. This is what CMS expects from physicians. It is necessary
to monitor each member’s HCCs for ensuring consistency in reporting.
5.
As new diagnosis codes get added or old ones get
deleted every year, physicians must work with an updated codebook.
About
247 Medical Billing Services:
We
are a medical billing company that offers ‘24/7 Medical
Billing Services’
and support physicians, hospitals, medical institutions and group practices
with our end to end medical billing solutions. We help you earn more revenue
with our quick and affordable services. Our customized Revenue Cycle Management
(RCM) solutions allow physicians to attract additional revenue and reduce
administrative burden or losses.
Contact:
247 Medical Billing Services
Tel: +1 888-502-0537
Email: info@247medicalbillingservices.com
Contact:
247 Medical Billing Services
Tel: +1 888-502-0537
Email: info@247medicalbillingservices.com
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