Lunch and Learn – July 2017
How do we get paid for physician services in medical practices? Watch this 10 minute video and download the handouts below for an overview of HCC diagnosis coding. Also see the billing guide and other diagnosis coding resources here.
In the past, payment has been based on what we do, the CPT code, or HCPCS code billed on the claim form. In a fee-for-service world, payors use diagnosis codes to establish the medical necessity for the service.
That changes as we move into accountable care organizations (ACOs), shared savings programs, or risk-adjusted contracts with commercial payors.
With these models, the payor is using diagnosis coding to establish how sick our entire panel of patients are. They then use that information along with utilization, quality data and patient satisfaction to change the amount we get paid, not on the individual claim, but at the end of the contract year. Either as a bonus, a penalty, or a rate adjustment.
This first of three modules gives an overview of HCCs (Hierarchical Condition Categories). In August, Betsy will review compliance related issues and in September, how to evaluate the accuracy of your diagnosis coding.
Be sure to download the companion resources below.
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