You can be forgiven if you missed it among all your holiday frivolity, but CMS released a proposal for the latest risk-code update. It’s significant.
And I read it so you don’t have to.
The bottom line?
If adopted, pay special attention to collecting all the HCC groups for your dual-eligible patients—that’s where the low hanging fruit is.
- There are two proposed models under discussion—one that includes two additional conditions (pressure ulcer codes and dementia) and one that does not.
- Both will award “extra” risk scores for the number of HCC groups submitted for the patient—not risk codes, HCC groups. The more HCC groups associated with a patient, the higher the risk scores. The bonus starts with patients who have codes that map to a total of 4-5 HCC groups (depending on demographics) and max out at 10 HCC groups or more.
- The “extra” conversion factors are different for each beneficiary group—they are higher in “dual-eligible” disabled patients and least in the “aged-in” population.
- These are proposals only, the final rule will be released in 90-120 days
- If accepted, the revised coding system will be phased in over three years 2020-2023.
That’s what the battlefield looks like—more on tactics next week.