Clinical evidence based retrospective patient record review to accurately capture the acuity level of patient populations based on hierarchical condition categories (HCC) coding. Comprehensive review of both patient face-to-face encounters as well as diagnostic testing.
Key Features
Missed HCC opportunities: On chart review, practitioner appropriately documented the condition but 'missed' capturing the acuity during billing.
Suspect HCC opportunities: Chart review show clinical evidence and diagnostic testing suggesting 'suspect' conditions in the patient that need to be assessed and evaluated by the practitioner in a face to face visit.
Undocumented HCC opportunities: HCC evidences captured from the Lab/Path/Rad reports, but condition not confirmed by the provider.
Validate billed HCC conditions as per MEAT/TAMPER guidelines.
Problem list clean-up as we do the historical data scrub.
Clinical-Decision support recommendations for providers based on disease burden of the patient coupled with HCC findings.
