A veteran HCC coder, Gloria Rodriguez has seen the pros and cons of many approaches to HCC coding. At the beginning of her career, she “chased” and reviewed paper patient charts. Next, she reviewed electronic records through the EHR system or scanned PDF charts. Gloria currently reviews charts using Apixio’s HCC Profiler application. By using HCC Profiler she has reduced her data entry error rate and doubled her productivity.

About Gloria: Gloria currently codes charts for Kelsey-Seybold, a health plan in Houston, Texas which operates 19 multispeciality care centers and services more than 400, 000 patients.

Goals:

• To increase HCC coding accuracy and completeness
• To put expert coding skills to best use and eliminate administrative “grunt” work
• To create a simple, easy coding workflow that facilitated an enjoyable work experience
• To enable better insights and quality assurance of work.

Approach: Gloria used Apixio’s HCC Profiler, a HIPAA-compliant cloud application that transforms the complex chart review and HCC coding process into a simple, intuitive workflow where coders are presented with evidence for one HCC code at a time, and asked to confirm or reject the findings.

Results: Gloria went from reviewing 3-5 charts per hour, to reviewing 8-10 charts per hour, with fewer data entry errors. She is happier with the type of work she is doing and has more time for provider documentation improvement education and personal enrichment.

Chasing and reviewing paper charts is an exhausting process

At the beginning of her career, Gloria coded HCCs for a large provider group.

The provider group gave Gloria a list with the number of patients at each physician office whose charts required a risk adjustment audit. Gloria contacted the physician offices and arranged to pick up charts for these patients. On the agreed-upon day, Gloria drove to the physician’s office, collected the pulled charts, and reviewed the charts onsite, working out of a file room or employee common room.

A big pain point with this system was that only handful of physician offices Gloria was assigned to used an EHR, meaning that most of the patient charts Gloria read were handwritten. If a provider had bad handwriting, Gloria had to reach out to an office manager for assistance, and wait till they had time to help her. This dramatically slowed chart review.

Additionally, the provider group required that all HCCs be entered into their proprietary HCC coding software. When transferring codes and supporting information from her working Excel file to the HCC coding software, it was easy to err and transpose the numbers in an ICD-9 code or misspell a name.

Most significantly, though, the process of traveling to chase down charts and work around a physician office’s daily schedule was stressful and exhausting. The provider group required Gloria to collect and review at least 150 charts per week— in just 40 hours.

PDFs are often a disorganized jumble and difficult to work with

Next, Gloria worked with a third-party contractor to serve a provider group with widespread EHR adoption. Through the contractor’s system, all the relevant medical records were scanned into a PDF file, which Gloria would review.

The notes were easier to read, because they weren’t handwritten, but other than that they were still very difficult to work with. The patient files could be anywhere from 1 to 1000 pages, and would contain all types of information, from lab and diagnostic tests results, to patient encounter notes, to patient letters. The pages came in no particular order, were sometimes upside down, and some pages were missing altogether.

Reviewing directly in EHR is easier, but still leaves room for data entry error

Gloria eventually gained direct access to the provider’s EHR system, thereby gaining access to better-organized patient charts. However, reviewing them still requires auditing with a naked eye. Productivity remained less than 5 charts per hour. And with both the PDF review process and the EHR review process, Gloria needed to transfer the HCC codes she found from the Excel spreadsheet that she worked with to a special coding system that the provider grouped preferred, which left room for data entry error.

HCC Profiler enables increased personal productivity and fulfillment

Gloria began to use Apixio’s HCC Profiler during her work with Kelsey-Seybold. Gloria did not have to go chase charts down from physician offices; in fact, she didn’t even have to read them by hand. Apixio’s HCC Profiler read the patient charts, identified potential HCCs along with supporting evidence, and presented them to Gloria for quick confirmation or rejection. It didn’t show Gloria codes that had already been identified by Kelsey-Seybold, so she didn’t do any needless work. With HCC Profiler’s dynamic search functionality for  ICD-10 and provider identification, and pre-fill of the member name, she was at lower risk for data errors and much more productive.

Most importantly, she was able to review charts quickly and accurately. With HCC Profiler, Gloria completes eight to ten charts per hour, up to 80 charts per day. She has time for advanced projects such as physician documentation audits and professional education. She was able to work out of the comfort of her home, and had the space to take a break— in fact, Gloria’s eyesight improved. It’s a far cry from the days of driving from office to office searching for charts, and it’s a process that respects Gloria’s value as an expert resource.