A growing number of healthcare organizations are adopting the value-based care model, prompting a stronger emphasis on clinical documentation. That’s because the level of detail generated at the point of care has direct ties to reimbursement amounts, improved patient outcomes, quality metric reporting, and more.
The oversight of a chronic condition – such as an HCC (hierarchy condition category) – that goes unaddressed in the calendar year can significantly impact risk adjustment factor (RAF) scores and care reimbursement. In fact, a research study from 2020 found that incorrect medical coding, including mistakes in HCC coding, can cause up to a 12% loss in potential revenue for healthcare institutions annually.
Many provider organizations are looking for ways to safeguard their documentation against errors and oversight, exploring how more efficient workflows in the clinical and administrative realms – including with payers – can have mutual benefits.
So, how can organizations start achieving this? By improving the usability of patient data and bridging the clinical and administrative worlds through a feedback exchange.
Check out the following video to learn more or keep scrolling for key insights.
DISCUSSION
Exploring assisted patient documentation and diagnosis refinement tools for Oracle Health Millennium
1. Improve the usability of patient data
Physicians are not coders by trade, nor do they wish to spend excessive time in the electronic health record (EHR). It’s a conundrum for administrators who have to nudge them for additional details; after all, they rely on precise documentation for a multitude of needs. If relevant patient data is more readily available to the provider – clean of redundant diagnoses and presented within an organized structure – it alleviates the mental strain commonly felt by physicians when interacting with the EHR.
During a recent IMO Heath hosted event, Ashley Beaty, Director of Clinical Informatics at Marshall Health, stated, “Having everything right there and accessible and in a nice, clean, clear picture is very invaluable to [providers].”
Beaty is referring to how IMO Core, a solution designed to enhance medical problem lists, facilitates optimal ICD-10-CM coding and streamlines HCC management, improving providers’ visibility into a patient’s clinical story. Not only does IMO Core organize and curate the patient’s chronic problems list, but it also integrates payer-identified HCC gaps that previously had to be reviewed through a non-integrated workflow.
2. Establish clinical and payer feedback
Providers need up-to-date and reliable data, and payers require clinical relevance, documentation accuracy, and coding specificity. So, establishing a feedback exchange with payer-sourced data presents clear benefits for both parties.
For instance, the proper integration of payer-sourced data, such as that supported by IMO Core, can help identify appropriate encounters for interventions, ensuring physicians receive actionable, evidence-backed recommendations within the clinical workflow of the encounter. It’s a smart approach to securing the right data at the right time.
With IMO Core’s payer integration, Marshall Health was able to find “another way to draw attention to the provider and make sure the HCC is captured year over year,” Beaty remarked. “[Providers] are giving me the feedback, ‘I really didn’t realize I was under-coding my patients so much and that there was so much more detail that you could add to that diagnosis to really dial it down and paint a clear picture of the patient.’”
This proactive feedback exchange builds collaboration between payers and providers and not only maximizes reimbursement but helps prevent conditions from worsening, which in turn reduces high costs, hospitalizations, and poor health outcomes.
Overall, as value-based care models spread, health systems should invest in the usability of their data and take actionable steps to bridge the gap between clinical and administrative teams. By ensuring providers have access to clean, well-organized data and actionable feedback from payers, organizations can simplify workflows, improve HCC capture, and optimize reimbursement.
