OP HCC Process and Reporting

Hello. Can anyone share, if they have EPIC, their HCC process for PCP office visits? We have an HCC CDIS tee up the provider in the system but are having trouble with the follow-up process to see if the suggested HCC was documented on by the provider. It's been a clunky cumbersome process for both the providers and the CDI staff. Looking for a streamline process to keep providers from getting frustrated. Also, what kind of reports are being used to show progress in the HCC CDI program?

Thank you.

Abby Belcher, MS, RHIA


  • We have WQs/Charge Routers set up for the offices we are in for post visit reviews for the coders to review the documentation and codes.

    We use HCC capture rate right now as metrics.

  • Hi - we are currently developing a process for OP office visit reviews and HCC capture opportunities. Can anyone share their productivity standards for these type of reviews?

    We are currently looking at our clinic volumes and trying to project the # of FTEs we might need. Of course, we will start small, not target all at once, but any productivity info you might be willing to share would be of great help to us.

    Thank you,

    Elizabeth Owens, RHIA, CDIP, CCS

  • We currently do prospective reviews. We look at the charts going back 2-3 years looking at everything and write queries as needed. We get about a chart an hour done. That also includes following up on queries from previous days. We plan on starting prebill also so that may change ours a little .

  • Hi, do you have any software? Also what EMR is used in your clinics. We have just started CDI in two Family medicine clinics. We are tracking everything in Excel and then providing the physicians an excel spread sheet with our queries a week in advance.

  • We have patient WQs set up to identify patients with an appointment in the next 7 days for all of the payer plans we are participating in incentive plans with. We then review those encounters prospectively, cross-referencing with open suspects condition data from the payer. We add a flag to the encounter if we leave a prospective query in EPIC or if we need to review retro for any reason. The flag stops billing and drops the encounter in a charge review WQ. Once CDI finishes the after visit review, we remove the flag to allow for coding/billing.

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