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New Updates from CMS for 2022 Payments

The new updates from Centers for Medicare and Medicaid Services (CMS) for 2022 Medicare Advantage Advance Notice Part 1 – Risk Adjustment proposes the move to fully encounter based data capture for Medicare Advantage payment.1
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Current HCC Coding Approach

  • Manual processes
  • Pulling charts ahead of a patient visit to look for conditions that should be captured
  • Sticky note reminders
  • Retrospective review after the visits

New HCC Approach
A Better Way

  • Real-time, software using chart data
  • Automatic during the encounter
  • Recommendations delivered based on chart evidence at the right time in the clinicians existing electronic health record (EHR) workflow

Only alerted when there is a suggestion that may
help guide the provider to improve coding accuracy.

Community Health Network sees positive financial impact of more than $7 million with actionable HCC alerts. 2

Despite financial hardships of COVID-19, this health system had a financial impact with 10 actionable HCC alerts in 2020 and 33 alerts in 2021.

$700 PMPM
Medicare Advantage
$800 PMPM
Next Gen ACO
Medicare Advantage &
Next Gen ACO
(10% of attributed lives)

10 actionable HCC alerts resulting in

25,687 alerts triggered in 2020

57% average follow rate

2020 Impact:

$4,945,0003

33 actionable HCC alerts

21 HCC Categories

9,922 HCC codes documented

2021 Impact:(January-March)

$2,397,0004

“The HCC alert was followed 64% and if you are familiar with alerts in an EMR, a follow rate of 64% is nearly a miracle. We shoot for 40-50% as a gold standard so to have it at 64% tells you that providers really were accepting of this workflow and the alert when appropriate.”

Patrick McGill, MD – Chief Analytics Officer, Community Health Network

Actionable HCC Alerts help providers identify new codes not previously documented.

Benefits of HCC Alerts

Available in EHR Workflow

Actionable HCC alerts are made available in the EHR at the point of care and are designed to assist a provider in identifying whether a new or different HCC code should be considered by a provider to optimize diagnosis coding.

Suggests New Codes

Our HCC alerts are not solely reliant on prior coding history, nor do they focus primarily on the recapture of codes. This helps enable providers to identify new codes that have not been previously documented by providers, which may result in a year-over-year increase in RAF scores.

Expanded HCC Content

We offer more than 40 HCC alerts covering a variety of conditions including diabetes, Alzheimer’s disease, benzodiazepine and opioid dependence, chronic kidney disease and more that can be made available as part of your clinical decision support (CDS) library.

Actionable Alerts

The alerts are designed to be actionable within the EHR workflow and built to limit the provider’s administrative burden by avoiding the need to remember to update the code later or navigate to a different part of the EHR to complete the task.

Provider Efficiencies

The alerts are designed to increase provider efficiencies across the care continuum, with the goal to help improve patient care, risk score outcomes, billing compliance and the potential to optimize Medicare Advantage reimbursement.

“Remarkable results begin with great partnerships. Community Health Network and Stanson Health are a perfect example of bringing together technology for the improvement of performance while improving the provider experience.”

Patrick McGill, MD – Chief Analytics Officer, Community Health Network

What Can Stanson’s HCC Solution Do For You?

 

This is an advertisement for services. Results and savings will vary based on individual circumstances. Links are accurate at the time of publication. HCC alerts are not intended to replace the independent clinical and/or coding judgment of any healthcare provider.
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  1. 2022 Medicare Advantage Advance Notice Part I – Risk Adjustment. (2020, September 14). Retrieved September 16, 2020, from https://www.cms.gov/newsroom/fact-sheets/2022-medicare-advantage-advance-notice-part-i-risk-adjustment
  2. Information regarding covered lives, per member per month rates and HCC multiplier data submitted by Community Health Network. Data calculated from Stanson Analytics from January 1, 2020 – March 31, 2021. HCC coding alerts that resulted in a code being placed were used to determine the estimated financial impact of the HCC alerts.
  3. Information regarding covered lives, per member per month rates and HCC multiplier data submitted by Community Health Network. Data calculated from Stanson Analytics from January 1, 2020 – December 31, 2020. HCC coding alerts that resulted in a code being placed were used to determine the estimated financial impact of the HCC alerts.
  4. Information regarding covered lives, per member per month rates and HCC multiplier data submitted by Community Health Network. Data calculated from Stanson Analytics from January 1, 2021 – March 31, 2021. HCC coding alerts that resulted in a code being placed were used to determine the estimated financial impact of the HCC alerts.