Wiki HCC Coding Changes

[consultingbykristin]

Hi,

I've been hearing that there are big changes coming for HCC coding. I've read through most...but the one 'rumor' I'm hearing and trying to confirm, I haven't been able too so I need help:

What I'm hearing is that CMS is going to start focusing on those HCCs submitted only once by a specialist and perhaps not count it, if it isn't also captured by the PCP. This is supposedly for 2014 DOS affecting 2015 payments.

I need a link to official information about the change as I need to begin the training of physicians, etc.

Has anyone heard of this or anything sounding like this? If so, I appreciate any and all feedback and links to whatever supports this being a definite change are also appreciated!

 

[camillecoder@hotmail.com]

I don't recall seeing anything that discussed what you describe. I'm wondering if it was a reference to the Risk Assessment flags. There is some concern about using the Risk Assessments as a dx reporting source without appropriate physician follow-up. See Attachment II, Section H in the Advance Notice.

This is what was announced in the Final Notice:
MA Enrollee Risk Assessments: In response to comments received on the proposed policy for MA Enrollee Risk Assessments, CMS is delaying the collection of “flags” for these assessments until 2014 dates of service. We will propose and finalize a policy on the extent to which diagnoses from 2014 Enrollee Risk Assessments will be used to calculate risk scores for payment year 2015 in the 2015 Advance Notice and Rate Announcement.


Here are links to the Advance Notice and Final Notice.

http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/downloads/Advance2014.pdf

http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2014.pdf

 

[camillecoder@hotmail.com]

I just re-read Section H in the Advance Notice and I can see how your providers may have misinterpreted this information. This is related th the Risk Assessments as I noted in my previous post. The approved provider type would be a typical physician or midlevel provider, regardless of specialty, such as primary care, cardio, neuro, etc. An approved provider would NOT include types such as lab, DME, radiology, etc.


To better ensure that our payments to plans reflect diagnoses for which there has been an
associated treatment or that have been diagnosed by a treating provider, for payment year 2015, CMS is considering excluding, for risk adjustment payment purposes, the diagnosis data collected from MA enrollee risk assessments that are not confirmed by a subsequent clinical encounter by a provider type that has been approved for risk adjustment purposes. We invite comment on this proposal.