Leaders need to make sure their revenue cycle teams have a sequence of importance for SDOH codes to uphold the organization's overall goal.
CMS recently released the fiscal year 2024 inpatient prospective payment system final rule, and within it, CMS finalized a higher severity level designation for three different social determinants of health (SDOH) codes describing homelessness.
More than 80% of hospitals are collecting data on SDOH—many right through their EHR platform and health information exchanges—yet only half of those hospitals are collecting data regularly.
As revenue cycle leaders continue placing a heavier focus on capturing SDOH codes, having CMS continue to increase severity level designations will continue to promote their use.
While SDOH data collection is top of mind, what revenue cycle leaders might not realize is that only a certain number of SDOH codes will fit on a Medicare claim—meaning revenue cycle leaders need to make sure their middle revenue cycle has a sequence of importance for SDOH codes in order to uphold the organization’s overall impact goal.
While the bill goes to the insurance company, only the top 25 diagnostic codes are billed for the inpatient side and it’s even fewer for the outpatient side, Kimberly Cunningham, instructor for the certified coder boot camp programs at HCPro, explained in a recent webinar.
“So, now there’s a potential conflict—should coders report SDOH codes within that top 25 and leave out some other codes that may be impactful for patients that have more than 25 codes on an inpatient claim or 12 on an outpatient claim?” Cunningham asked.
CMS’ decision to finalize the severity level designation change for homelessness codes has likely pushed those SDOH codes to the forefront of the coders’ and billers’ attention.
However, Cunningham says that for the remainder of the SDOH codes, individual organizations need to determine the sequence of importance for SDOH codes for themselves. For example:
- What are the outcomes that the organization is hoping to have?
- How is the organization hoping to impact patients?
By answering these questions, leaders can determine what they view to be of the utmost importance when capturing data. From there, they can make sure teams are reporting the associated diagnosis codes according to their levels of importance. This, in turn, will aid programs that the organization seeks to implement, Cunningham says.
“Outreach programs, insurance companies, and programs rely on this data being reported. Organizations may need to focus on specific SDOH codes and determine what they want to report,” she says.
Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.
While SDOH data collection is top of mind, what revenue cycle leaders might not realize is that only a certain number of SDOH codes will fit on a Medicare claim.
This means leaders need to determine the sequence of importance for SDOH codes to fit the orginization's strategic goals.