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Old 06-16-2018, 09:26 AM
tpers01 tpers01 is offline
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Question BPCI Advanced

If anyone is currently working through BPCI Advanced, do you think the actual target price construction may be extremely sensitive to CDI and HCC coding?

Scenario 1: Hospital institutes a very good CDI (Clinical documentation initiative) and maximizes, albeit properly, the CC/MCC triggers for DRG payments at a disproportionate rate to their peers. Under this scenario, I would imagine that the average HCC score for the patients would be lower than facilities that do not maximize the CC/MMC triggers. This would have a negative impact on the BPCI Advanced target through a lower PCMA adjustment.

Overall this should be ok, seeing that they are getting paid more for the CC/MCC anyway.

Scenario 2: Health system is recognized through MA shared savings programs as having lower than average HCC scores and implements measures to appropriately code ambulatory visits and increases average HCC scores. By my estimation, this would likely have a direct impact on increasing the HBP and target price amounts in the performance period by increasing the amount in Step 3 without doing much to the efficiency score and/or PAT.

Thoughts??
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Old 07-12-2018, 05:01 PM
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sjb554 sjb554 is online now
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Originally Posted by tpers01 View Post
If anyone is currently working through BPCI Advanced, do you think the actual target price construction may be extremely sensitive to CDI and HCC coding?

Scenario 1: Hospital institutes a very good CDI (Clinical documentation initiative) and maximizes, albeit properly, the CC/MCC triggers for DRG payments at a disproportionate rate to their peers. Under this scenario, I would imagine that the average HCC score for the patients would be lower than facilities that do not maximize the CC/MMC triggers. This would have a negative impact on the BPCI Advanced target through a lower PCMA adjustment.

Overall this should be ok, seeing that they are getting paid more for the CC/MCC anyway.

Scenario 2: Health system is recognized through MA shared savings programs as having lower than average HCC scores and implements measures to appropriately code ambulatory visits and increases average HCC scores. By my estimation, this would likely have a direct impact on increasing the HBP and target price amounts in the performance period by increasing the amount in Step 3 without doing much to the efficiency score and/or PAT.

Thoughts??

Sorry this is a bit late!


Patient case mix happens for each ACH, so what your peers are doing shouldn't matter (at least in terms of risk scores). Also, the patient case mix is updated in step 20, so if coding changes over time it shouldn't affect the reconciliation by much.
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