Implementation Of a Hierarchical Categorial Condition (HCC) Coding Education Plan in Eight Rural Primary Care Clinics: A Quality Improvement Project to Accurately Capture Patient Health Risk

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Assessing patients’ health risk is a complicated process with broad clinical and financial implications. This study’s focus is to increase the Hierarchical Categorial Condition (HCC) coding recapture in eight rural Montana clinics through an education and incentive program, therefore increasing the accuracy of the Medicare patients’ health risk, as estimated through a Risk Adjustment Factor (RAF). This intervention occurred between September 28th and December 31st, 2021. The “capture” of HCC codes resets at the beginning of every year and therefore an intensive focus for accurate health risk is centered on recapturing the HCC codes. Two primary methods were used to increase HCC recapture. First, there was an aggressive educational campaign that included recorded videos, creation of clinical champions at each clinic site and interface with expert HCC Coders. Additionally, a tiered incentive bonus structure based on panel size, employment full time equivalent, and percentage-based zones of HCC recapture for Physicians and Advanced Practice Providers was implemented. The culmination of these methods resulted in an average improvement of 7.4% in Montana HCC recapture during the study period, with four of the eight clinics meeting the 80% HCC Recapture goal. There was also an increase of average RAF by 0.3 points, for a total RAF of 1.11, a 27% improvement. Implementation of substantive incentive, coupled with an aggressive educational program, improved HCC recapture, and subsequently helped accurately reflect the patients’ health risk reflected in the increase RAF.



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