Several years ago, Vanderbilt Medical Group’s (VMG) Ed Odom, MD, internal medicine physician and assistant professor of clinical medicine, began pursuing ways in which coding and documentation could enhance patient care delivery. Dr. Odom is now a champion of change for coding and documentation improvement efforts, serving on the Vanderbilt Department of Medicine’s Coding and Compliance Educational Committee.
One of his missions is to educate colleagues on how to leverage Medicare Annual Wellness Visits (AWVs), document HCCs and improve RAF scores while staying in compliance with the coding and documentation requirements for those visits.
Dr. Odom’s work has had a positive effect on VMG’s coding practices, helping the medical group to increase coding compliance and improve RAF scores while maintaining an impressive completion rate for AWVs. Read on for Dr. Odom’s Medicare AWV best practices:
Educate providers. Many providers have a lot to learn about coding best practices. At VMG, Dr. Odom’s committee helps providers by underscoring the importance of risk adjustors and how they play into AWV reimbursements. Provider understanding is one of the biggest factors in improving billing for AWVs.
Promote the importance of an AWV. It can be challenging to schedule patients for their AWVs—let alone encourage them to come into the office to get them. Some patients with chronic illnesses have so many specialists that they may not see the need for an additional visit with their primary care provider, Odom says. For their part, providers may not feel comfortable with the criteria and coding requirements of AWVs, so they are hesitant to push their patients to get one. Again, education is key—for both patients and providers—so everyone understands the vital importance of these annual visits.
Identify quick wins. There are so many HCC diagnoses that risk-adjust that it’s nearly impossible to understand all of them in detail. That’s why it’s best to prioritize the “low-hanging fruit” Odom says.
“We performed an audit at VMG to determine which HCC diagnoses were and were not being submitted appropriately,” Dr. Odom says. “Certain diagnoses were being missed or not coded appropriately so they weren’t being to risk-adjusted correctly.”
Diabetes is an area that is ripe for improvement, he says. VMG was seeing a high percentage of patients with a diabetes diagnosis that were being categorized with the code for “diabetes without complications.” A closer look revealed that many of those patients had renal complications, hyperglycemia or other issues that have a higher risk adjustment score than uncomplicated diabetes.