Success Codes The Next Generation—Disease Burden

Late last year, in response to the 21st-Century Cures Act,  CMS released its proposed tweaks to the risk-coding system.

 

 

They’re not huge, but they will make a difference.

 

 

Especially if you incorporate the coding in your changes now and get ahead of the game.

 

 

The most novel change involves your patient’s total disease burden.

 

 

Starting in 2019, your patient’s overall risk score will be adjusted based on their total disease burden.

 

 

“Total Disease Burden” is defined as the sum total of their illnesses with a risk-adjustment assigned to them.

 

 

For example, atherosclerosis of the aorta, a diagnosis with a risk score would be included in the calculation.  Benign Hypertension, which does not have a risk score, would not.

 

 

Once all the risk scores are added together, an additional risk score based on that sum will be added based on the total.

 

 

By now you must be thinking that this is getting a little confusing—well here’s the bottom line.

 

 

The value of each risk code you submit just got amplified by a little bit.

 

 

How much is still to be determined by CMS, but worth more they have previously been.

 

 

 

This means a little extra reward in your efforts to find, address and submit every appropriate risk code for your patient.

 

 

It makes the whole process that much worthwhile.

 

 

But remember, higher risk scores DO NOT necessarily mean extra revenue.

 

 

CMS adjusts the value of each risk code down as more are submitted.

 

 

So you may just be risk coding to stay in place.

 

 

But with this new adjustment, staying in place just got that much easier.

 

 


 

 

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