Wiki HCC auditing tools

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coder1

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Good Afternoon Coding World,

Do anyone have any information they can share regarding audit tools for HCC coding practices. I currently work for a large provider company that see Medicare Advantage patients. Any information will be helpful this is my first week working for the company.

Thanks in advance.
 
HCC program management

I know this is an old thread but I am looking for tools and tips on how to better manage a HCC program. If there is anyone out there that has experience with how to manage a large HCC program that would be great. I was hired to take over this program but no guildelines or protocols are in place in the organization and we have 72 out patient locations with 400+ doctors. my email is spraxl72@gmail.com. Thank you in advance.
 
spraxl72@gmail.com said:
I know this is an old thread but I am looking for tools and tips on how to better manage a HCC program. If there is anyone out there that has experience with how to manage a large HCC program that would be great. I was hired to take over this program but no guildelines or protocols are in place in the organization and we have 72 out patient locations with 400+ doctors. my email is spraxl72@gmail.com. Thank you in advance.
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Optum Ingenix has extensive educational information to train your providers and coders/auditors.

I have worked as an HCC physician auditor. In our department we were responsible for providing each physician with an annual audit of all their HCC patients. We pulled our reports from a software called revenue max. This diagnosis detail report printed out every patient with a participating medicare advantage plan and all previously diagnosed chronic conditions. Then we were responsible for:
auditing the entire chart (for the specific payment year) for each patient for the provider we were auditing.

Our main focus was education. So we would identify all missed opportunities for that payment year. Discuss proper documentation based on ICD 9/10 guidelines (i.e. diabetic causal relationships, acute stroke vs. late effects). We would also query the physicians on conflicting dx's, the patient problem list, etc. In the EHR that we used the Problem list was carried forward on each encounter/record and the provider would pull the diagnoses from that list. So as you can imagine if an incorrect code was listed in error. The provider selected this code for their assessment for the duration of that year. We would get the providers permission/sign off for us to go in and update the problem list to reflect the correct codes based on physician documentation and the providers clarification.
 
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