Wiki HCC Reviews

[smihm]

Would anyone be willing to share their current workflow for HCC chart reviews?
Are you doing Prospective or Concurrent reviews ? My group is doing prospective reviews- we are looking through the chart prior to the upcoming appt , identifying potential HCC conditions- so the Physician can assess at time of visit - this has been very successful.
Due to recent changes in some of our risk based contracts , I am leaning more toward concurrent reviews as the particular payer is solely using codes submitted on the claim. The down side to this at least from what I can tell - is my staff would not be "data mining" the entire chart - as time would not permit. I do believe do both prospective and concurrent together is the most beneficial, however staffing is a an huge
Any insight would be greatly be appreciated
Thanks

 

[macmuffin1]

We do retrospective, prospective and concurrent, placing all chronic conditions in the problem list as well as in an Alert/FYI box or what ever your EHR system has available, so that they are addressed at least 1 time per year during the annual well visit. This is beneficial for both Medicare and Marketplace as you are able to follow all conditions year over year and keep a timeline of changing and or escalation of disease processes and a quick overview of the Patient. We also have chart preparation for those Physicians that prefer a paper document to work with and make notes on rather that a computer.