Hierarchical condition categories (HCCs) are another hot topic on the
practice council. “HCCs are an example of new payment methodologies
that payers like Medicare Advantage plans are using and that are really
growing,” says Mary H. Stanfill, MBI, RHIA, CCS, CCS-P, FAHIMA, vice
president of consulting services for United Audit Systems, Inc., Cincinnati,
OH. She also co-chairs the CTC Practice Council, which released a practice
brief on “Documentation and Coding Practices for Risk Adjustment and
Hierarchical Condition Categories” last year.
Stanfill says it is essential for HIM professionals to be aware of the potential
impact of new payment methodologies on their organizations. She points
to the PDPM as an example. Under this model, having an accurate primary
diagnosis code on the minimum data set (MDS) assessment tool is critical
to ensure that a claim is not automatically returned to the provider. She
says coding professionals can help the MDS nurses who compile patient
data in the tool understand the implications and prepare for the change.
This requires a deep understanding of the coding guidelines as well as
critical thinking skills.
As new payment methodologies continue to emerge, Stanfill says HIM
professionals also can support more robust data governance in their
organizations. “We need to have the knowledge and skills to review and
recognize aberrant data patterns and develop policies to validate coded
data,” she says. “That historically has not been part of the coding practice,
but as we gain efficiency through automation, we need to use that extra
time to analyze coded data patterns to detect and fix data defects in a more
systematic way. It is those of us with coding knowledge who will be able to
recognize those data patterns.”
s COVER STORY CONTINUED
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