Main Library
It’s 2024, and we’re living in a digital world. Yet far too many healthcare providers are making do with outdated and incomplete methods for collecting, analyzing, and using medical records.
With the rollout of CMS-HCC V28, the publication of TEFCA 2.0, and the continued push for national interoperability, now is the time for value-based care organizations to augment their risk adjustment efforts with better technology and additional support.
There are 3 key areas that require the most attention as we adapt to the changing landscape: medical records retrieval processes, record structure and readability, and the automation of manual processes.
What’s Changing with HCC Coding?
Under the V28 model, more than 2,000 ICD-10 codes have been removed from the current risk adjustment model. This means that providers have to be much more precise with their diagnoses to avoid missing out on premiums.
Incorrect or unsupported diagnoses can result in payment retraction or fines during Risk Adjustment Data Validation audits.
On the other hand, overlooking a diagnosis lowers the patient’s RAF score and adversely affects the provider’s premium from CMS.
These consequences were already a significant source of concern for at-risk provider groups. But now that the list of HCC codes is shrinking, it’s more important than ever to code accurately and to catch all diagnoses.
And yet, the current systems for medical retrieval, storage, and analysis are not sophisticated enough to give providers the support they need for accurate, efficient coding under these new rules.