You had better be savvy with your coding
Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lori E. Rousche, MD, a family physician in Souderton, Pennsylvania. She is also the hospice medical director for Grand View Health in Sellersville, Pennsylvania. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
With the change in payment focusing on quality medicine instead of the old-fashioned fee for service, providers better be savvy with their coding or they will lose out on the money needed to run their practices. As individual and groups of physicians align with other groups to provide excellence in care while cutting costs, it is essential that the providers learn to code properly.
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Our practice has joined with the local hospital to form an Integrated Delivery Network (IDN). As primary care providers, we will work with our community hospital and specialists to cut costs by decreasing the use of the emergency room and decreasing admissions to the hospital. We have also aligned with Tandigm Health, a physician-led group that uses experts in business, nursing and informatics to focus on ways to save money by decreasing hospital admissions, readmissions and ER visits.
One of the most important things to the success of these endeavors is accurate hierarchical condition category (HCC) coding. There is a major emphasis on coding properly in order to increase risk adjustment factor (RAF) scores and allow the above organizations to start with a bigger pot of money.
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If more money comes into the entity to start, there will be more money, theoretically, to trickle down to the doctors in the trenches to support our work with our patients. This extra money that can be earned going forward with other ventures such as Medicare Shared Savings Program (MSSP) and Comprehensive Primary Care Plus (CPC+) will be reinvested in the practice to support better care of our patients, with post-discharge phone calls, post-hospitalization home visits and better overall support of our sickest patients.