HCC Validation Return on Investment

Client Profile:

Large Multi-Specialty Group comprised of 60+ office locations and Urgent Care Centers located in the Northeast.

Challenge:

Leadership of the group identified a need to review coding and documentation for opportunities to improve document details relating to patient care and conditions being addressed and treated.  The objective was on identify HCC’s and improve RAF scores through our global coding support team.

Approach:

AQuity Coding Leadership worked with the client to evaluate their coding and documentation and identify any trends. After confirming our findings and offering recommendations to their leaders and physicians, collaboration began on how to monitor and report on the impact/return on investment of the project.  Global leadership focused on identifying coder/auditor skillsets and training on the group’s systems and the workflow requirements.  Ongoing communications between teams was key and continue with weekly calls to review results and recommendations.

Results:

The AQuity global Coding Services team identified the following opportunities for improvement:

  • Validation/review support for 10 specialties encompassing 132,831 encounters
  • Detected 73% of encounters with an HCC opportunity
  • Recognized more than a 34% increase in HCC code capture
  • Identified areas of improvement relating to:
    • Diagnosis specificity
    • Documentation of all conditions being treated and addressed during the visit
    • Documentation of conditions to support medications being ordered and/or that the patient is currently taking
    • Recommended deletion of conditions not supported

To learn more about AQuity Solutions coding support services, contact us today at info@aquitysolutions.com.

NOTE: See table below for quantified HCC Return on Investment results.

roi-table

CATEGORY

Medical Coding Services

LATEST SUCCESS STORIES

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