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LuckyLily

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Local Chapter Officer
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Hi Everyone,

I am trying to gain information on organization work flows on how they get HCCs captured. For example, do you send something to your providers to prompt them that certain dx's were captured the year before and it needs to be recaptured? Do you only do chart reviews and abstract the HCC's out of that before claim is sent out? Do you review for HCC's after the claim went out and due post review?

I'm just curious on how other organization's handle the process. If you don't want to post directly on this forum, you can send me a private email through this site.

Thank you
 
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We work with several different types and sizes of organizations and each one manages this a bit differently.

The first approach most organizations use is provider training - HCC 101, why it's important and what it means to the bottom line $$$.
Second many groups are doing mid year (or retrospective) chart reviews and audits, scoring providers and then performing very targeted training.
Third we have seen some (mostly larger groups) who have reviewers abstracting prior to the claim going out...however this can be costly and timing is critical.

We are aware of one EMR vendor who is working to provide prompts related to HCC.
 
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LuckyLily said:
Hi Everyone,

I am trying to gain information on organization work flows on how they get HCCs captured. For example, do you send something to your providers to prompt them that certain dx's were captured the year before and it needs to be recaptured? Do you only do chart reviews and abstract the HCC's out of that before claim is sent out? Do you review for HCC's after the claim went out and due post review?

I'm just curious on how other organization's handle the process. If you don't want to post directly on this forum, you can send me a private email through this site.

Thank you
Click to expand...

Payor/Health Plan work flows?
 
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