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Learn MoreOctober is often a month of change, be it the weather or the annual rollout of Internal Classification of Diseases (ICD) code additions, removals, and changes. Not as spectacular as fall foliage, perhaps, but just as vital in terms of proper patient-care recording, denial reduction and maximum possible revenue capture.
The 2018 ICD-10 update involved 473 published changes. That included 279 new codes, 143 revised codes and 51 deleted codes. The standout this year is the attention paid to Hierarchical Condition Categories, or HCCs, says Susan Gurzynski-Wells, MS, RHIA, Senior Product Manager, Revenue Cycle, for HealthStream.
“What we’re starting to see is a drilling down into the things affected by HCCs, which means a lot of external codes are expanding,” Gurzynski-Wells says. “In previous years we’ve seen code updates more along the lines of ‘Oops, this didn't’ fall in the particular place where it should,’ and now we’re seeing more code updates in the line of specificity.”
Focus on Hierarchical Condition Categories (HCCs)
The HCC focus has exposed a shortcoming in most healthcare systems. According to a survey performed by the Association of Clinical Documentation Improvement Specialists, “Only 10 percent of hospitals currently possess an outpatient CDI program. However, survey data also shows outpatient CDI is becoming more common; more than 20 percent of respondents indicated that they plan to cover outpatient and/or physician services in the next six to 12 months. Clearly, this is an area of growth and opportunity.”
That means that all patient coding, wherever that patient is seen, will need to be followed carefully in order to ensure coverage determinations and reduce the possibility of denial. It also means that diagnoses around HCCs, which normally fall into the physician-practice arena, now can fall into outpatient CDI more frequently because those patients aren’t just being seen in doctor’s offices. Or, in other cases, those patients aren’t being seen at all.
Coding Oriented More Fully to the Continuum of Care
“The HCC-related coding changes are being done to make sure that dollars being paid to physicians align with making sure that the sicker patients are being treated,” Gurzynski-Wells says. “At the same time, they have to make sure all their patients are documented as well. If you have someone who’s not a good patient, who only goes in when they are sick, If they miss an appointment, they may not be documented that year, and so are not included in that seen-patient list for HCCs. That can affect reimbursement.”
“The best way I heard it explained was when someone said, ‘We’re not a hospital system, we’re a health system that has hospitals.’ We must look at that continuum of care, and make sure that coding is represented all along it. A facility may have great admission volume and a good CMI [case mix index] and still be losing money every month. Because of all the multiple care settings we have now, we have to focus on the documentation and the coding in each.”
The MEAT of the Matter
A sound way of making that happen is through training around the Monitor, Evaluate, Assess/Address and Treat, or MEAT, acronym. HCC documentation should reflect all those areas, and here's how that breaks down:
As with any major shift that includes treatment , documentation and reimbursement, training will be essential. The rise of the physician advisor, a clinically trained doctor who can bridge the gap between documenting for quality and documenting for reimbursement, without losing sight of the importance of each, is one example of how the healthcare community is responding. Those individuals, along with doctors, coders and others, however, will still need to be brought up to speed on ICD-10 shifts around HCCs and any other changes that may come along in future years.
“We have begun to introduce a series of webinars in our nThrive education curriculum and have begun to incorporate the changes into our other curriculum,” she says. “We have changed 86 courses so far, along with many incubators, simulation labs and assessments. We will continue that work so that all the latest ICD-10 changes, especially those around HCCs, are reflected in our materials.”
Learn about HealthStream Revenue Cycle Education Solutions.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
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View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
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View All ProductsIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
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View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream's solutions allow your healthcare workforce to be confident and competent with the knowledge they are upholding the highest of standards.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
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View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
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