HCC Consulting Case Study: Bridging the Gap Between Medical Software Companies & Coding

HCC Consulting Case Study: Bridging the Gap Between Medical Software Companies & Coding

HCC coding, consulting, and auditing is one of YES HIM Consulting’s many niche specialties. With decades of combined experience navigating the HIM Coding industry, our consultants have the real-world knowledge your team needs to bridge the gap between technology and medical coding. Our team has developed processes through first-hand encounters that help medical software companies better understand documentation and reporting guidelines.

During a recent HCC consulting project, YES consultants assisted a medical product software company with research, analysis, and recommendations for proper documentation alignment, a report template for the client’s product, and a review of the product’s original FDA clearance statement.

hcc consulting

HCC Consulting Case Study: The Findings Revealed

For the project’s first component, YES consultants researched in-home assessment documentation processes and the reporting journey of similar products. From our years of experience in the healthcare industry, our team reached out to various in-home assessment companies via telephone and email to understand the full scope of their processes for the client.

Based on the research and analysis and our expertise in healthcare technology, YES recommended that the client make their software compatible with laptops and tablets, so it remains easily accessible for in-home assessments. In addition, they advised that the software should generate a detailed report that can interface with various healthcare provider EHRs and insurance systems.

In the second component, our team researched the required documentation to support an HCC diagnosis, and provided a report template for appropriate detailed documentation and proper reimbursement. The client was advised to follow the M.E.A.T. Criteria process for documentation and assigning the proper HCC code(s). To support an HCC, the patient’s medical record must support the presence of the disease/condition and also include the clinical provider’s monitoring, evaluation, assessment and/or plan for management of the disease/condition.

Using YES consultant’s expertise in pathophysiology, HCCs, and the M.E.A.T. Criteria documentation, our team developed a form that included examples of the necessary presentation factors and risk factors to assign a product-specific HCC grouping.

For the final component of the project, YES consultant’s subject matter experts reviewed the client’s original FDA clearance statement. Comparing it to that of several similar products, YES was able to determine the client’s original FDA clearance statement was accurate and complete.

How Can YES Help Bridge the Gap for Your Company?

YES helps medical software companies bridge the gap between medical coding and technology. How can YES help your team today?

For additional information regarding HCC consulting, risk adjustment models, M.E.A.T. Criteria, and specificity in documentation, review these resources:

Karen Youmans

Karen G. Youmans, MPA, RHIA, CCS – President, YES HIM Consulting, Inc. AHIMA-approved ICD-10-CM/PCS trainer
HCC consulting case study

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