HCC Retrospective Audits, Is it Worth it?
Effective HCC recapture is a reconfirmation process, somewhere between a census and an audit. It establishes that patients are still covered, and their conditions are still managed year over year. What it doesn’t do is account for new conditions. It is also subject to constant attrition even when performed perfectly; patients move to other areas, obtain other methods of covering the costs of their care, or they pass away.
This is why a recapture program is absolutely necessary but, at the same time, only a first step. HCC recapture does not necessarily account for increased levels of coding severity for previously documented conditions through comorbidities or progression. It doesn’t capture conditions of new members of a population at all. To fully grasp the breadth and depth of conditions within a population, it requires experts in their fields to double and triple up their expertise, with doctors often learning basic coder practices, and coders making up any gap with thorough research through clinical notes. Unfortunately, with 80% of all clinical data being unstructured, this is a profoundly intensive process which is difficult to undertake manually, even with an army of clinically trained researchers and coders.
We champion HCC recapture because it’s absolutely critical, but it’s only as good as the initial confirmation process. The confidence of knowing that the unstructured clinical data that had been captured over the years is now going to work to ensure that the greatest possible capture rate is achieved should bring comfort to that concern. All leaders want to know they’re seeing a more complete and accurate risk profile than before and that the data is finally going to work for them.
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