Recorded June 6, 2018
Presented by Betsy Nicoletti with guest speaker Edwin Knights, MD
Edwin Knights, M.D. was the physician leader in his practice in implementing risk diagnosis coding and brings experience and strategic knowledge to this important topic.
Many practices have a basic understanding of HCC risk adjusted diagnosis coding, but still struggle with improving the accuracy of the diagnosis codes submitted on claim forms.
Medical groups that are part of an ACO or have commercial risk adjusted contracts will see decreasing reimbursement from payers if they don’t review their frequency reports, educate clinicians and improve their documentation of conditions submitted on claim forms.
This webinar will describe the action steps practices can take to find and report diagnosis codes accurately in a risk adjustment environment.
After the session, participants will be able to:
- Describe the concept of risk adjusted diagnosis coding
- Identify three conditions to review
- Develop a plan to accurately report these three conditions
Review of diagnosis risk scores using Hierarchical Condition Category (HCCs) and why it matters
Assessment of current diagnosis coding
- What to look for in your ICD-10 frequency report
Start with frequently reported conditions
- Depression, obesity, diabetes, addiction, chronic diseases, status report
Problems areas (problems and pitfalls)
- Compliance issues related to neoplasms, stroke, and MI ?
- Inaccurate and incomplete problem lists
- Failure to link related diagnoses on the problem list
- Conditions on problem lists not assigned at least yearly on a claim form
Addressing physician resistance:
- Reluctance to assign certain conditions due to their stigma.
- Reluctance due to awkward terminology required by CMS for some mental health diagnoses
- Reluctance due to the delay between the onset of the diagnosis and its appearance in the patient’s problem list
- Reluctance due to the need to address patient questions and concerns about these “new” conditions
- Reluctance due to lack of staff help with finding, adding, and linking diagnoses
- Reluctance to add adequate documentation of all assessed diagnoses the narrative of the visit.
Advanced techniques (strategies)
- Reviewing reports from specialists, ED’s, hospitals, and diagnostic test results; reviewing medication lists for medications that suggest a risk-adjusting diagnosis.
- Adding conditions identified on reports and results to the problem list
- Reminding physicians of needed assessments just before scheduled visits.
After the webinar, see the CodingIntel Guide to Hierarchical Condition Categories for a comprehensive list of HCC and Risk Adjusted Diagnosis Coding resources available on CodingIntel.
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