Complete and accurate coding does more for health plans’ bottom lines than preventative medicine alone
Health care costs are a major concern for many Americans right now. Employers and individuals who do not qualify for subsidies are struggling to budget for the increased costs of the Affordable Care Act, and health plan providers are facing the challenge of offsetting the costs of increased numbers of high-risk patients with pre-existing conditions that may be enrolling in their plans. HCC coding has long been an important way for health plans serving Medicare enrollees to ensure they receive maximum reimbursement for care provided. Now, more than ever, it’s clear that a combination of accurate coding and excellent patient care will be required for health plans to be successful.
Two Important – But Not Equal – Cost Management Strategies
When it comes to economics, health plans need to start with HCC coding rather than basing their cost-management strategies solely on disease management. According to Al Lewis, president of the Disease Management Purchasing Consortium, this approach can save health plans up to 10 times as much as disease management alone. As he put it in an interview with Managed Care magazine in 2008, “Best practices in a disease management program can save perhaps $200 per high-risk Medicare life. Yet from a coding perspective, these plans are often paid $2,000 less than they should be paid for these members because of under-reporting of ICD 9 codes.”
Even today, experts still say that health plans are leaving money on the table through inaccurate or incomplete coding. The introduction of the new ICD 10 codes may make this situation worse if health plans aren’t prepared. By directing more resources towards HCC coding, health plans can significantly improve their financial positions. Therefore it is apparent that hiring additional HCC coders or even outsourcing coding activities completely to a company like HCC Coders can be an excellent investment.
HCC Coding Supports More Effective Disease Management
Of course, disease management, or providing less expensive preventative care to patients in order to avoid or forestall more expensive and serious medical problems, should not fall by the wayside. Disease management helps patients just as much as it helps health plans. HCC coding can be used to support this activity. If a rigorous and complete coding process is applied to each Medicare patient at the beginning of each year, there is a better chance of underlying health conditions getting detected and treated in accordance with existing disease management protocols. HCC Coders can even provide retrospective risk adjustment services to ensure that all codes have been captured accurately and help your health plan be as successful as possible.