health revenue

Posted and filed under Coding, Healthcare.

Like most clinics, your office has probably decided to accept Medicare Advantage plans by now. So what is your plan of attack? Most providers are going to say that it is time to get each patient enrolled in these plans into the office for the all-important health assessment. Most office managers are going to prepare for the onslaught of lab tests, increased staff responsibilities, and the need for additional training. These ideas are logical conclusions that will pay dividends now and in the future, but have you thought about last year? How about 10 years ago? Probably not.

You are probably asking why you should care about what a provider assessed 10 years ago for a patient you are seeing today. Surely your qualified healthcare professional will accurately diagnose them today, and you could very well be correct. Then again, what about the patient that was diagnosed with major depression ten years ago but was the epitome of happiness today? Will your provider catch that and diagnose them with major depression in remission thus securing a few more dollars to cover the added risk of hospitalization for that patient? The answer is likely a resounding “no” and they are not alone.

One key way practices can generate better overall MRA scores for their patient populations would be to dedicate resources to analyzing previous documentation. Most providers do a good job of knowing what has happened to their patients in the last year or two. In complex cases, they may be aware of some significant health history prior to that. Generally speaking though, the older the documentation is the less likely they have reviewed the sometimes hundreds of pages of records which in turn increases the chances of missed revenue. This is why it is imperative that someone with a coding AND clinical background is dedicated to reviewing this documentation.

Since Medicare Advantage Plans originated from the Balanced Budget Act of 1997, the idea of managed care is still relatively new. Ten years ago it would have been much easier to start from scratch and build MRA scores from the ground up. Today, one key improvement that the Medicare Advantages have provided is that clinics have made a concerted effort to appropriately diagnose and document key chronic conditions. This turn of events has made it increasingly important to dig in order to find the already documented HCC codes, as well as looking for the ones that were missed. This time consuming but vital work is easily overlooked but will provide fruitful results.

Many clinics struggle with implementing a plan to extract the codes from the sea of information. Still others just do not have the skilled personnel to do so even if they wanted to. At Advize Health, we have staff with experience in extracting these codes for you. If you are interested in learning how we can significantly improve your MRA scores and increase revenue contact us today!