Mastering hierarchical condition categories (HCC) is key to success under new reimbursement methodologies that rely on risk-adjustment, quality, and value metrics such as the Quality Payment Program (QPP). Organizations need to take a close look at their training and audit programs to ensure that valuable information isn’t being left out of documentation—and negatively impacting HCC scores.
Patient care continues to move from the inpatient setting to outpatient. With this change, the challenge of securing comprehensive documentation that articulates the services rendered and the patient care provided now needs to extend across the care continuum.
Length of stay (LOS) management requires ongoing attention from the director/manager of case management to stay on budget. Directors who divert their attention, even for a few weeks, might find themselves spending too much. To avoid this situation, consider implementing the six best practices for LOS maintenance.
Tom, a 29-year-old, unemployed construction worker living on the East Coast, decides to drive on his own to the West Coast in hopes of finding a job. He avoids rest stops to decrease his total trip time. Halfway through his trip, he gets in a serious auto accident caused by another driver. The accident occurs in a state with mandated auto insurance.
