A large hospital system from the east coast was concerned about poor documentation and its effect on their RAF (Risk Adjustment Factor). The data for the hospital system’s geographical location indicated a sick patient population of 44%, however, their hospital system data recorded the sick patient population at 35%
The hospital approached Vee Technologies with these concerns. The General Manager of Coding at Vee Technologies suggested a plan that included a retrospective sample audit for all physicians for a given period. As part of the review, Vee Technologies would capture the current risk scores based on the claims submitted, and upon reviewing the medical records, would suggest updated risk scores. Additionally, Vee Technologies would capture clinical documentation improvements by providers and clinics.
The Hierarchical Chronic Condition (HCC), also known as Risk Adjustment coding, is designed to access future healthcare costs of patient populations by assigning risk scores based on the diagnosis. HCC helps hospitals better understand sick patient populations to plan/provide the best care for patients. The accuracy of documentation and corresponding codes captured are critical to determining the exact risk condition with the highest specificity. The Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) are currently accepted by most payers to assess risk populations, and accordingly, allocate money for patient care. However, this will transition exclusively to EDPS by 2020, making the accuracy of documentation even more critical at the encounter level.