Helpful Tips for Bridging HCC Care Gaps in Medicare Advantage (MA) Plans

 The Centers for Medicare and Medicaid Services (CMS) pays MedicareAdvantage (MA) Plans for each insured participant, giving preference to older and disabled adults who meet the criteria. Apart from hospice care, the MA coverage is the same as Part A hospital, Part B medical, and Part D prescription medication coverage.

Instead of being provided by the federal government, the Medicare Advantage Plans, often known as Part C or MA Plans, are provided by Medicare-approved private organizations that must adhere to Medicare's regulations. They often include hospitalization, medical care, and prescription medication coverage. Healthcare companies get a predetermined monthly premium for insurance coverage and charge enrollees for out-of-pocket expenditures.

MA Plans and Hierarchical Condition Categories (HCC Coding)

CMS-HCC Coding system compensates Medicare Advantage Organizations (MAOs) differently depending on condition prevalence and demography. Approximately 9,000 ICD-10 codes are classified with a risk factor. Weighting or a stratification assigns higher scores to more severe issues. Must report conditions annually under the HCC Coding framework.

Bridging HCC Care Gaps and Ensuring Effective Code Tracking

It is critical to document all HCC codes for the ascribed members to provide correct risk adjustment scores and total payer allocations.

Healthcare organizations can close HCC Care Gaps by following these helpful tips: 

1)      Check Patients once a year

Diagnoses must be obtained through face-to-face consultations and reported on an annual basis. Plan ahead of time and develop comprehensive outreach strategies.

2)       Plan ahead of time for patient visits

Assist physicians in identifying HCC patients ahead of time so that activities like chart prep, issue list reviews, and morning huddles can be more impactful and focused.

 3)     Use Appropriate Forms

Use Patient Assessment Forms (PAFS) or Comprehensive Health Assessments (CHAs) to collect comprehensive and accurate diagnoses at the point of care.

 

4)      Automated chart review process 

Utilize techniques to monitor high-value interactions that require coder review, optimize your workflow, and guarantee that HCC coding is completed before claim submission.

 

5)      Determine Performance Indicators

Evaluate the Key performance indicators and data that the team should monitor to operate successfully, and then develop timely, consistent reports on important reimbursement drivers like:

 a. Recapture rate of HCC (by location and provider)

 b. Patient risk adjustment score trending

 c. Patients with severe illnesses that must be scheduled

  

6)      Assemble the Correct Team

Healthcare providers must receive assistance to finish the documentation and HCC data analysis. If required, consider hiring additional support personnel.