Alliance coding work group: Health New England case studies

Event Date: 4/28/2016

Event Overview

Archived webinar event

Session description:

This call is one in a series designed for the Alliance coding work group. These calls showcase one health plan at a time, whose team is responsible for sharing two case studies with the other group members for discussion.
- The case study charts will be shared at least two weeks in advance of the call, and made available on the coding work group's collaboration site.
- Participants will review the charts in advance and bring documentation regarding how they would code and why.
- The discussion will be moderated by Health New England's named facilitator, who will summarize input and ultimately phrase the best practice identified.
- The goal of each call is to arrive at a resolution for each “problem chart,” and document that resolution for the benefit of all Alliance members, with referenced literature/materials substantiating the decision.
- Alliance staff will assist in preparing the final documentation from each call, and the facilitator will review for accuracy prior to posting to the member website.
- Any remaining time during the call will be available for open discussion, which could be used to:
  - Review the most recent online conversations between coders on the Alliance website.
  - Best practices could be called out and highlighted, with additional clarification and discussion as needed
  - Potential inaccuracies could be explored and follow up assigned to members of the group for the next call, if needed.
  - Proven inaccuracies could be flagged for removal from the site, as needed.

Attendee Feedback

"Very educational and interactive meeting." - Heidi Mattson, SelectHealth

"Great meeting, lots of good information. Thank you for pulling this group together. I anticipate that as everyone gets comfortable with the process there will be even more discussions." - Christi Isaac, Health Alliance Medical Plans

"This was my first time attending this meeting. It was really interesting to have the opportunity to hear how other organizations interpret the coding scenarios which were presented. I have been an HCC coder since 2009. I have always felt it is extremely important to have an outlet to come together with other coders/department managers in the HCC risk adjustment field to openly discuss these challenging cases. I really appreciate everyone's willingness to share their departmental decision making processes. I look forward to future meetings." - Kristen Reed-Pearson, Providence Health Plan

Documents

5/6/2016

recap: Coding work group April 28
The Health New England team compiled take aways from our April 28 webinar for the Alliance Coding Work Group

4/28/2016

Recording: Alliance Coding Work Group - Health New England Case Studies

4/15/2016

Coding work group case study chronic condition in routine exam
It is argued that, according to ICD guidelines, providers should not bill for chronic conditions at routine examinations, even if addressed.

4/15/2016

Coding work group case study prostate cancer current vs history
These two "problem charts" have been submitted by Health New England for consideration by the Alliance coding work group, and address the issue of coding cancer current vs. history.