15 – Improving Risk Adjustment Coding Accuracy with Analytics (financial, operations)

The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to estimate predicted costs for Medicare beneficiaries, and the results directly impact the reimbursement healthcare organizations receive. CMS requires that all qualifying conditions be identified each year by provider organizations. Documentation that is linked to a non-specific diagnosis, as well as incomplete documentation, negatively affects reimbursement.  Despite providing care to a patient population that is not significantly less complex than the national population, Allina Health’s HCC coding for CMS risk adjustment was historically lower than both national and regional averages for Medicare ACO cohorts.  Discover how it optimized its EMR, data, analytics, and provided widespread education to enable better documentation of care for patients with chronic diseases, leading to more accurate HCC risk adjustment coding—and more appropriate compensation for the quality care it provides.

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