The transition from fee-for-service to value-based care reflects a broader shift towards a more sustainable, efficient, and patient-centered delivery of care– a transition that MDaudit proudly supports through technology and analytics.
In the pursuit of billing compliantly and maximizing value-based care reimbursement, hierarchical condition category (HCC) coding ranks high on the list. The proposed Medicare Advantage 2024 Advance Notice released by the Centers for Medicare and Medicaid Services (CMS) begins implementation this year. While the CMS-HCC model V28 will be phased in over the next three years, this change comes at a challenging time for the industry.
Hierarchical Condition Category and Quality Scoring
Two areas specific to successful value-based care reimbursement are HCC coding and effective tracking of quality scores. The MDaudit platform contributes to both by providing actionable insights into HCC coding quality inaccuracies. The platform also makes it easy to identify claims with HCCs and streamlines the audit process to perform prospective and retrospective review. Finally, MDaudit can calculate the overall weight changes associated with HCC coding changes.
Healthcare providers participating in value-based care reimbursement models often undergo HCC audits to accurately assess and predict patient risk and to allocate the appropriate resources. These audits play a crucial role in capturing and documenting the severity of chronic conditions, as they directly influence risk adjustment factors in reimbursement calculations. In the context of value-based care, these audits become essential for ensuring that the reimbursement accurately reflects the complexity of patient populations.
HCC Coding: V24 vs V28
CMS’s proposal for V28 brings increased categories and complexity. This proposal takes HCC coding categories from 86 to 115, with the categories undergoing renumbering (Coding Intel). While current diagnosis coding practices are not expected to change, risk scores will.
Organizations are encouraged to invest in technologies supporting high-volume clinical documentation alongside coding accuracy. This combination enables health systems, providers, and other stakeholders to effectively manage their risk adjustment programs directly correlating to successful outcomes across billing compliance, coding, and revenue integrity.
MDaudit supports this initiative by ensuring that the acuity of an organization’s patient mix is accurately reflected in its claim submissions. Our auditing workflows and data-driven approach ensure that HCCs are coded with the highest levels of accuracy and integrity and track overall HCC weight changes.
We believe healthy outcomes are rooted in the daily internal clinical processes around patient care. By providing the appropriate technologies and tools necessary to continuously monitor and identify at-risk billing patterns, MDaudit lessens the burden of administrative tasks on clinicians and allows them to reprioritize their focus on providing quality patient care.
MDaudit supports the ongoing transition to value-based care through our single, secure, cloud-based platform. Learn more today!
