What Is Risk Adjustment Coding?
As the healthcare industry moves from a reimbursement methodology based on volume to one based on value, accurately capturing all the conditions of your patient population has never been more important. More and more payers are negotiating reimbursement based on the risk of the provider’s patient population and are moving away from traditional fee-for-service reimbursement. Though there are many vehicles through which the risk of a patient population can be calculated, the main variables in all of these algorithms are a patient’s diagnosis codes.
These complex algorithms take in all of the patient’s chronic conditions and produce a score that determines how much money a provider should spend on taking care of their patients in a year. Without accurate capture of a patient’s diagnosis codes, providers could be receiving reimbursement at a level that does not reflect the health of their population. This can lead to inaccurate reimbursement and a decrease in quality of care.
A risk-adjustment review can occur at three different times throughout the revenue cycle:
- Retrospectively: After a claim has been billed
- Concurrently: Before a claim has been billed
- Prospectively: Before a patient is seen
A review of this kind is an invaluable tool for health plans, ACOs, and providers to ensure that they are compensated accurately and are providing their patient population with the highest level of care. Lighthouse Healthcare Advisors can help you implement risk adjustment coding strategy. Contact us at 410.252.0804 to learn more.
How LHA Can Help with Risk Adjustment Coding
Our team has experience in helping organizations better understand risk adjustment coding and how to increase their accuracy. We can help your organization achieve optimal reimbursement for its patient population. In this industry, failing to keep up with these changes can cause you to quickly fall behind. However, Lighthouse Healthcare Advisors exists to ensure that you are optimizing revenues while providing high-quality care.
Risk adjustment using HCC framework is fundamental to physician reimbursement, patient and population health management, and supporting value-based programs. With Lighthouse Healthcare Advisors, you get a customized approach to clinical documentation review and improvement.
We follow a focused, four-step program to improve the accuracy of your patient panel risk score through accurate documentation and coding.
- Step 1: Identification of high risk/high utilizing patients utilizing your existing analytics platform or through our proprietary tool
- Step 2: Comprehensive patient chart review resulting in the identification of clinical documentation deficiencies and notification of required diagnostic tests
- Step 3: Timely notification linked to next patient visit for appropriate clinical documentation and code specificity
- Step 4: Workflow redesign and practice transformation strategy to promote efficient and accurate documentation which supports accurate diagnosis code assignment
LHA is the perfect partner to help you start or enhance your risk adjustment coding reviews. We are the first in the industry to offer prospective reviews so that your provider feels confident in what they need to document before they even enter a patient’s room.
Our team will work to understand your organization’s unique strengths and weaknesses. Accurately and efficiently implementing risk adjustment coding can help you grow. Scheduling a consultation can be an important first step in growing your business and discovering new opportunities.
Contact Lighthouse Healthcare Advisors Today
Lighthouse Healthcare Advisors is made up of industry experts who are committed to helping healthcare systems, organizations, and providers change and adapt to the ever-changing healthcare landscape. We partner with our clients to assist with management strategy, finance, process improvement, and compliance. If your organization is ready to take the next step, our healthcare advisors can help.
We provide a high level of implementation support as your organization goes through the transition into utilizing risk adjustment coding, and you’ll experience the benefits right away. In addition, we provide a wide range of consulting services, including the following:
- Healthcare management consulting
- Coding, compliance, and education
- Contract review and fee negotiating
Whatever your organization needs, Lighthouse Healthcare Advisors can help. Our team of industry experts has vast experience in leading physician practices, psychiatric practices, urgent cares, and a wide range of other healthcare organizations to success. Take the first step and reach out to our team today at 410.252.0804 or contact us online for a consultation.