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Help Increase HCC Coding Accuracy, Efficiency
and the Bottom Line at the Point of Care

Our Clinical Decision Support (CDS) can help organizations capture hierarchical condition category (HCC) codes by implementing alerts to prompt providers to add the necessary codes in the electronic health record (EHR) workflow. The goal of HCC documentation is to capture a patient’s true clinical picture and achieve accurate risk scores while providing high-level care. The HCC guidance is designed to be actionable, and is built to limit the provider’s administrative burden and ensure accurate reimbursement.

Community Health Network Sees Financial Impact of More Than $13 Million1,2

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.

With HCC Tech, Bellin Health Improves RAF Score by 16 Percent3

“I either need to continue doing what I’m doing and performing at the level I’m performing, or I need to change something. For me, the change was incorporating HCC capture into the workflow.”

Dr. Shane Degen – Assistant Medical Informatics Officer, Bellin Health

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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.

AI-enabled, Evidence-based Solutions
Designed by Clinicians

Bon Secours Mercy Health Improves HCC Coding Accuracy

“I came to the table as a skeptic. My initial reaction was that the alerts are too much of an ask on the provider. But the data was what really convinced me. We are seeing high follow rates of these alerts from providers which is extraordinary. It exceeded all expectations.”

Mark Binstock – Chief Medical Information Officer, Bon Secours Mercy Health

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Mark Binstock

What Can Our 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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Stanson Health

Sources

  1. 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, 2021. HCC coding alerts that resulted in a code being placed were used to determine the estimated financial impact of the HCC alerts.
  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, 2022 – March 31, 2022. HCC coding alerts that resulted in a code being placed were used to determine the estimated financial impact of the HCC alerts.
  3. Based on interview with Bellin Health, June 13, 2022.  Final story on Premier Inc. newsroom.  https://premierinc.com/newsroom/success-stories/physician-documentation-improvement-software-helps-bellin-health-improve-raf-score-by-16-percent PDF opens in new tab
  4. Based on interview with Bon Secours Mercy Health, March 16, 2022.  Final story on Premier Inc. newsroom.  https://premierinc.com/newsroom/success-stories/improving-hcc-coding-accuracy-with-stanson-healths-pinc-ai-clinical-decision-support-at-bon-secours-mercy-health PDF opens in new tab