Passing the HCC Audit: What You Need to Know

Lisa Knowles, Harmony Healthcare’s Compliance, Education and Privacy Officer, once again shares her expert knowledge at the national level with her recent article featured in Compliance Today. The Health Care Compliance Association publication, features Knowles in its April edition, on Passing the HCC Audit: What you need to know.

The HCC Risk Adjustment model is subject to audit by CMS and its contractors, this article shares what you need to know to pass the HCC audit and discusses five troublesome areas that auditors will scrutinize when calculating the risk adjustment factor used to determine financial capitation for physicians, physician groups, health systems, and Medicare Advantage plans.

Five tips are shared for passing the audit:

  1. Diagnosis codes are based on the ICD-10-CM guidelines for the current fiscal year.
  2. Medical record documentation is key and must support the code assignment.
  3. Each face-to-face encounter must have a valid signature.
  4. A valid date of service must be on the documentation for each face-to-face encounter.
  5. Addendums are valid if based on an observation on the date of service.

To read the full article featured in Compliance Today, click here.

At Harmony Healthcare, we’re committed to helping health systems achieve and maintain a higher level of billing integrity to ensure reimbursement accuracy and compliance adherence. Our Revenue Integrity, Coding Audit and Validation Review services do more than uncover risks and opportunities for improvement; they offer measurable and sustainable results to keep you prepared for the uncertain levels of external scrutiny imposed by government regulation.

We have extensive experience helping clients navigate the changing landscape of healthcare. If you’re looking to minimize errors to ensure compliance and optimal reimbursement, contact us today.

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