HouseCalls leadership is setting the program up to fail. At a time when MA risk-adjustment coding is under the highest scrutiny it’s ever been and risk scores are still one of the main revenue drivers, they keep adding more internal metrics and efficiency targets that make accurate documentation harder, not easier. There’s a clear inverse relationship between coding to the level of specificity now required and pushing APC, completion %, and daily volume. You simply can’t maximize quality, compliance, and productivity all at the same time. Something will give. Right now it feels like leadership wants all three, which isn’t realistic in the current regulatory environment. This is exactly how programs end up with compliance problems.
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@pa tell them to see their eye Dr , which is what they need to do anyway . HC doesn't take the place of that exam - think about it
@f4 actually… those charts likely
Stopped coming back to you bc none of those diagnosis codes you mentioned risk adjust anymore under v28….. (which is why the company is laying off in such large numbers. The reimbursement structure has completely changed. It was needed to a point for sure, but…..that is why all of this is happening.)
@pa it’s not your fault. it’s so difficult because the age demographic we usually
see...Droopy eyelids won’t result in a clear image.
I find it hard to spend the amount of time I would like with the patient when they are flagged for 4 labs and a DRE exam. I feel like I turn into a lab tech at that point.
Any tips on DREs? I have yet to get qualify images on any of the patients I have had so far. Dirty image, poor technique. I spend 15+ minutes with patients who are SO patient with me and still can’t get a quality image. It makes me feel like a failure….
@f5 Absolutely! Just bare bones.
@f4 Same. A few times I included references from CMS coding guidelines when an overzealous “biller” bothered me more than I would like. Everything immediately stopped.
ALSO a message to all HOUSECALLS APC's.
Do you know what happens when you answer "NO CHANGE" on any charts returned to you that area asking for more specificity or for you to add a diagnosis?
NOTHING.
Nothing happens to you. You are not rewarded or punished for adding or not adding these codes. DO NOT DO IT. You will still keep your job.
When the audits come (and they WILL come), UHG will throw you under the train tracks AND the bus because all of their chart returns come with the comment that "all diagnoses are left up to the discretion of the APC." And that right there pretty much absolves them of all legal responsibility. DO NOT CHANGE YOUR CHARTS.
I spend my days now DELETING as many risk adjusted diagnoses as I can. These are bare bones diagnosis lists. I've always done this to some degree but now I am ruthless. Does it take more time? yes. Is it worth it to make all the screechers in chart review clutch their pearls and send charts back to me asking for immunodeficiency diagnosis and hyperaldosteronism and PAD (based on a 2023 Quantaflow reading LOL)---YES it is all worth it. And the returns have markedly slowed down. I guess somewhere in chart review/quality my name is on a list that says "don't bother."
Well said. Couldn’t agree more.
@ad APCs are not defrauding anyone.
@ad Sounds like you’re part of the problem.
@ac I did more as an RN than this.
My favorite is the housecalls people who come on here and act like their department was defrauding our own citizens for years
@OP don't you ever think "this job is d-mb" and mostly insignificant? The education part is important and we do catch things that are missed on occasion, but basically working as a RN and no where near NP scope.