Skip to main content

Analysis

Reviewing CC/MCC Capture

By Revenue Cycle Advisor  
   November 16, 2020

If CC/MCC capture is improved, that will also increase the organization's case-mix index and, therefore, its reimbursement, Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, FAHIMA, CHPS adds.

A version of this article was first published November 16, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

Q: What are the benefits to having coders review charts for appropriate capture of complications and comorbidities (CC) and major CCs (MCC)?

A: At the time of coding, coders can flag charts for which they were not able to identify a CC/MCC and send them back to the coding manager for review.

Alternatively, the organization can build pre-bill edits that will route inpatient claims without a CC/MCC into a work queue for further review by the coding manager or CDI staff.

“This process will also serve as a way to audit your coders’ and CDI staff members’ performance,” Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, FAHIMA, CHPS, chief operating officer of First Class Solutions, Inc., in St. Louis, Missouri saya. “If we find a number of cases hitting that queue where a coder missed a condition or the CDI didn’t query on a condition, we have a way to trend that performance and address any deficiencies that our staff may have.”

If CC/MCC capture is improved, that will also increase the organization’s case-mix index and, therefore, its reimbursement, Dunn adds.

“I’ve seen this process produce $40,000 a month on the DRG reimbursement—not what we charge, but the actual DRG reimbursement in a hospital with fewer than 300 beds. That’s nearly a half a million dollars a year,” she says. “So even if you have a person spending two hours a day looking at this queue, that will cost far less than the return of a half a million dollars.”

For more information, see "Gaining ground: Enhancing HIM integration in the revenue cyclein the November 2020 issue of HIM Briefings.

Revenue Cycle Advisor combines all of HCPro's Medicare regulatory and reimbursement resources into one handy and easy-to-access portal. News is not just repeated from other sources. It is analyzed by our Medicare experts so professionals can comprehend any new rule and regulatory updates thoroughly. Learn more.


Get the latest on healthcare leadership in your inbox.