INPT CDI HCC/RAF

moortc@chc.net

are any inpatient CDI programs querying for HCCs? Upper management heard at a webinar that our inpatient mortality data is linked to RAF score which can be improved by increasing HCC capture.  I am really struggling to get up to speed on this topic and how HCCs can have an impact on inpatient coding.

vparent@emhs.org

We do try to catch HCCs on the inpatient record. Their impact is mainly on risk adjustment but if you have PCP offices with patients that are covered by Medicare advantage and the HCC is captured prior to an office visit it helps in that payment as well. For example, if a patient has an appointment scheduled for the end of the year but has to reschedule, any HCCs that are documented on the inpatient side are reported. See resources below:
https://www.icd10monitor.com/improving-risk-adjustment-through-inpatient-hcc-capture
https://www.advisory.com/research/revenue-cycle-advancement-center/at-the-margins/2018/04/reimbursement

angela.clayberg@mwhc.com

We are currently querying for HCCs in the inpatient setting. We had an outside vendor who came in to identify where the opportunites are for risk adjustment.

jcjohnson@premierhealth.com

I think it depends on how you are wanting to risk adjust the case. CMS's risk adjustment does include HCCs. However, not all of them really do. For instance, we use Vizient and the HCCs do not play a big role with risk adjustment. I agree to what was mentioned before, and you need to determine what benchmark or benchmarks you are trying to hit. It may be helpful to connect with your quality team and see if they have data to share as to where your organization is falling short.