How Surgeons Should Code For Chronic Conditions In Value Based Reimbursement?

Surgical facilities coding for chronic conditions is now becoming a strenuous task as the healthcare landscape shifts towards value-based care. Value-based care implemented by the Center of Medicare and Medicaid (CMS) attempts in providing better care for individuals, improving health care strategies and reducing the cost of healthcare. A certified coder can be a great assist for your surgical facilities especially when your facility deals with chronic conditions and complicated interactions.

Documentation is one area every surgeon should try and improve a three-step process of surgical billing where recognizing, documenting, and coding of the patient’s condition. It provides the necessary patient information to make sure that the patient’s condition is monitored constantly in a chronic state. This documentation will provide you with a constant feedback system of the patient’s condition and leading the surgeon towards a more effective framework to ensure that the providers are following a quality measure that must be used for better value-based care. Chronic conditions mean that patients have to necessarily visit the emergency room and emergency hospital visit this will be costly care but documentation will help in reducing the care cost.

Detailed documentation help inpatient engagement an important part of value-based reimbursement. Chronic conditions of the patient are usually a combination of lifestyle and disease; documentation will help in physicians to provide an accurate recap on the condition.  Educating the patient about the condition and encouraging them about lifestyle changes can increase the incentive under value-based reimbursement.  Your documentation will act as a validated document for the authentication of the procedure which is a critical component of value-based care.

Surgical Coding With Hierarchical Condition Category (HCC) Coding 

Chronic conditions will be the main focus as we see a shift from fee for service to value-based reimbursement. There is a strong interest in the Hierarchical Condition Category (HCC) coding payment model. HCC are disease groups organized in the body system or disease process.

Patients with chronic conditions are allocated a risk score based on the overall health status, risk of the condition and demographic criteria. The risk adjustment factor (RAF) is used by Medicare as a statistical tool to measure the cost of healthcare. This is all done with ICD-10 diagnosis code to identify the future risk with the added cost which might require continuous hospital admission or ongoing condition for consistent funding.

The goal of RAF is to pay Medicare Advantage and prescription drug programs by adjusting payment for enrollees based on demography and health status.

For any provider with the HCC payment model is important and the providers should report the chronic condition patient. In a chronic condition, a patient might require extra care, so yearly reporting should be maintained. Though HCC provides all the necessary factors it’s important to report all conditions as the money funded for each patient can be put in a negative balance.

Process In Your Surgical Facility

Surgical Facilities should have policies and efficient process in place to support the billing system. The initial documentation and reporting of the diagnoses for chronic health care conditions. A constant eye on the Medicare Website to stay updated on the latest guidelines for the appropriate coding of HCC.

How Medical Billers And Coders (MBC) Help You

Medical Billers and Coders (MBC) with over 17 years of experience in medical billing and coding. We provide an end to end revenue management for your surgical facility with claim management and coding system for your chronic care.