HCC Coding Based on NLP Improves Risk Adjustment Process

Risk Adjustment (RA) is a quantitative technique that takes into account the underlying health problems and healthcare expenditures of health plan members when examining healthcare outcomes or spending. Risk Adjustment Solutions contribute to guaranteeing compliance and providing correct reimbursement for beneficiaries' risk expenses.

The COVID-19 pandemic imposed costs on the entire healthcare market, notably the risk adjustment segment.  The pandemic's turmoil has severe consequences, including a drop in preventative activities, including certain yearly medical and wellness appointments. Additionally, there have been some advantageous outcomes, such as the rise in provider usage of telehealth.

Even though, the prior year demonstrated a distinct possibility of being a year of enhanced risk adjustment activity. Consolidated Omnibus Budget Reconciliation Act (COBRA) limitations and rates have been reduced, and some have been eliminated, with the introduction of the American Rescue Plan Act of 2021. The bill reforms different healthcare insurance policies to expand Medicaid discount criteria and strengthen government financial help for insurance coverage, while also allowing the Affordable Care Act (ACA) to offer an off-calendar second opportunity.

The Significance of HCC Coding

As a large number of healthcare organizations have implemented value-based care, they are now searching for Risk Adjustment Solutions and advanced methodologies and approaches for detecting high-risk members/patients, as well as addressing gaps in HCC Coding and Centers for Medicare & Medicaid Services (CMS) payout.

Let's be honest, the success of a healthcare organization's risk adjustment program is dependent on mistake-free datasets to guarantee that its patients' risk scores appropriately represent their core health problems. Employ integrated, end-to-end risk adjustment solutions to gather comprehensive data with unparalleled precision and assist organizations in interpreting it to help HCC Coding and close gaps, enhancing outcomes for patients.

Cautionary notes for HCC Coding

Every year, risk adjustment scores are updated. Current diagnoses, including chronic diseases, must be reported annually by practices.

All health conditions that overlap at the time of the visit or have an impact on the patient's care should be coded since HCCs are cumulative.

It is not appropriate to code for conditions that have been treated in the past but no longer exist. If the disease or family medical history affects present care or influences therapy, history codes may be utilized as secondary codes.

Power of NLP

NLP empowers providers and care teams to take charge of their coding experience.

Health plans code with simplicity, speed, and accuracy to significantly enhance risk adjustment outcomes.

NLP can process millions of health records and diagnostic document files, producing super accurate insights with a higher success rate.