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The number of patients using Medicare Advantage (MA) is rapidly growing, making Hierarchical Condition Categories (HCCs) an increasingly important concept for revenue cycle staff to understand in order to guarantee reimbursement.
To accurately interpret and code physician documentation, the HIM department must employ a quality clinical documentation improvement (CDI) program and an effective query process. Building upon these programs is integral to the success of the HIM department, especially where ICD-10 is concerned, said Deborah Lantz, RHIA, during HCPro's audio conference "Auditing Documentation for ICD-10: Steps to Take Now to Prepare Physicians and Staff." Lantz is the director of HIM at St. Charles Hospital in Port Jefferson, N.Y., and an AHIMA-certified ICD-10 trainer.
A case manager at a meeting described how the family of a patient was pressuring her to change the patient from outpatient services to inpatient status. If she didn't help, the family pleaded, the patient would face higher costs for postacute care. The case manager bragged about how she held the line, despite the tears. However, others in the room didn't think the details of the case were as black and white as the case manager claimed. And some wondered whether "holding the line" at any cost is really what a case manager should be doing.
