HCC/RxHCC Risk Tutorial for SETMA Table of Contents - Setma.com

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High Complexity (99215)HCC and E&M CorrelationsBecause SETMA’s electronic patient record displays whether a diagnosis is an HCC, anRxHCC or both, and because our system aggregates the coefficients for all of the diagnoseswhich are documented in a patient’s care, it is possible for a provider to know on eachpatient he/she treats:1. The coefficient aggregate for the acute diagnoses documented for each visit.2. The coefficient aggregate for the Chronic Diagnoses documented for each patient.3. The coefficient aggregate which has not been evaluated on a patient for the currentyear.The following tables contrast:1. Medicare Fee-for-Service HCC/RxHCC coefficient aggregates with MedicareAdvantage HCC/RxHCC aggregates2. Medicare Fee-for-Service contrasted with Medicare Fee-for-Service E&M Codedistribution by provider name.3. All Payers HCC/RxHCC aggregates contrasted with E&M CodesThe following is a contrast between Medicare FFS and Medicare Advantage’s MeanHCC/RxHCC coefficient aggregates and their standard deviations. It can be seen thatMedicare FFS coefficient aggregates are significantly lo0wer than the Medicare AdvantageCoefficients.46
The question is, “Is this because the populations are significantly different?,” or is itbecause we have not been as effective in capturing HCC/RxHCC for Medicare Fee-for-Service patients?. Now that SETMA is participating in an ACO, where patients are alsorisk stratified as to cost and revenue attributed to that group of patients, we need to makesure that we are being as effective in FFS as in MA.The next display is of Medicare Fee-for-Service coefficient aggregates both for acutediagnoses which have been evaluated at a visit and the chronic diagnoses which representthe patient’s problem list for which he/she is being treated. Later, this is contrasted with theE&M code distribution for each provider.By implication, we think there is a correlation between the acute diagnoses’ HCC/RxHCCcoefficient aggregate and the E&M code. The higher the HCC/RxHCC coefficientaggregate for the acute visit, the higher it is reasonable to expect the E&M coding to be, IFthe documentation is present in the record related to two or more chronic conditions.47
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Page 45: Reviewing the Complexity of Medical
Page 49: Summary:The correlation between HCC

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