Hierarchical Condition Categories (HCCs) are a hot topic when discussing risk assessment and payment for the long term care of our 65 and older patient base. Medicare Advantage enrollees are provided ongoing care reimbursement based on a specific set of demographics and diagnosis code data submitted to the payer over the course of time.
As auditors we find ourselves facing the challenge of educating our Providers on the importance of documentation that is both accurate and complete in order to produce the proper risk assessment. If a patient has multiple chronic conditions, it’s critical that all underlying health problems are reported annually to provide an overall view of the patient’s care situation.
To help you navigate the often confusing risk assessment process, Swiftaudit now includes an easy to use HCC lookup as well as a basic ICD-10 risk score calculator.
Preliminary risk scores can be accessed directly from the list of CPT related diagnosis codes in each Encounter.
Or you can view HCCs and calculate risk scores from the Coding Tools option in the upper navigation.
Our HCC lookup screen will display the appropriate category cross reference to your diagnosis codes, as well as the risk factor associated with each.
As always, we’ll continue to keep an eye on current audit trends and needs in order to provide the best possible tool set for our auditors and the clients they service!
For more information on how risk assessment and scoring works, check out Dr. Tom’s blog post on Calculating RAF Scores.
Swiftaudit now gives you access to RVU and Physician Fee Schedule information with a quick click. You can access the RVU/PFS screens through the main navigation, or from the Actions dropdown menu in your Encounter Header.
Select your Medicare Locality and click Calculate.
We’ll fill your screen with useful data, including:
Geographic Price Index
RVU and calculated Physician Fee Schedules
Click on the displayed LCD and we’ll show you all the appropriate HCPCS codes that apply. Click on More Info for any LCD and we’ll zing you over to the official CMS site for comprehensive details!
And the best news is, we won’t charge a single penny more for this fabulous new feature! Our goal is to provide auditors with a powerful toolset to make your job easier – we want to make you look good.
If you haven’t tried Swiftaudit yet, visit us at Try It Free and take advantage of our absolutely free, no credit card required 30-day trial. Come see what you’re missing!
We know that educating your client on how to code accurately is a top priority, and we’re ready to help! Swiftaudit uses the National Provider Identifier (NPI) database to access coding data from the most recent Public Use Files (PUF) and compare your physician’s annual coding results with both local and national numbers.
From either the Provider list or the Provider detail screen you can select a graph that focuses on New or Established patients. With one click you can see how your physician measures up compared to others in the same specialty, the same zip code, or across the nation.
Use your mouse to hover over the graph and view distinct data point details for specific E&M codes. Or right-click to print your graph for a later presentation. Easy!