Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress Report

Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library. Click the Clinicals tab. In the Standard Reports section of the tab, click run next to Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress Report.

To access reports on the Clinicals tab of the Report Library, you must have the Clinicals user permission and the Report: Report Library: Clinicals permission. The Report: Report Library: Clinicals permission is included in the following roles:

• Practice Superuser role
• Report Reader role

Note: To activate the Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress report, use the Activate Reports page.

The Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress report is intended primarily for managers who want to assess the rediagnosis rates of patients with HCC diagnoses across an organization. You may want to export the report results to a data analysis program such as Excel, where you can assess rediagnosis success relative to opportunity by payer, provider, department, and HCC condition.

1. Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library.
2. Click the Clinicals tab.
3. Click run next to Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress Report in the Standard Reports section of the tab.
   The Run Report: Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress Report page appears.
4. Department — To report on patients seen in specific departments only, click Selected and then select the departments to include in the report.
5. Provider — To report on patients seen by specific providers only, click Selected and then select the providers to include in the report.
6. Insurance Product Type — To report on patients who are insured by specific insurance product types only, click Selected and then select the insurance product types to include in the report (for example, Medicare B-Traditional or Medicare Supplemental Plan).
7. HCC Description — To report on patients who were diagnosed with specific chronic conditions only, click Selected and then select the HCC descriptions of the chronic conditions to include in the report.
8. Insurance Reporting Category — To report on patients whose insurance plans fall under specific insurance reporting categories only, click Selected and then select the insurance reporting categories to include in the report (for example, AARP or Medicare B).
9. View Type — Select the report view from the menu (the Detailed view is selected by default).
• Detailed — Generate a report that displays each patient selected by the report filters.
• Subtotal by Department — Generate a summary report that displays diagnoses captured and missed this calendar year for the selected departments.
• Subtotal by Provider — Generate a summary report that displays diagnoses captured and missed this calendar year for the selected providers.
• Subtotal by Provider Specialty — Generate a summary report that displays diagnoses captured and missed this calendar year for the selected provider specialties.
• Subtotal by HCC Description — Generate a summary report that displays diagnoses captured and missed this calendar year for the selected HCC descriptions.
10. Report Format — Select the format for your report results.
• HTML table — Display the report results on your screen.
• Text (tab-delimited) — Export the report results to a .csv file in tab-delimited format.
• Text (comma-delimited) — Export the report results to a .csv file in comma-delimited format.
11. Report Options — Select report options.
• Suppress Column Headings — Select this option to remove column headings from the report results.
• Suppress Report Name — Select this option to remove the report name from the report results.
• Show Filter Criteria — Select this option to include your selected filter criteria in the report results.
• Run Offline (will appear in your Report Inbox tomorrow morning) — Select this option for very long reports. Reports that are run offline appear in your Report Inbox the morning after the request.
12. Click Run Report.

The Hierarchical Condition Category (HCC) model assigns a risk adjustment factor (RAF) to chronic conditions common in Medicare patients. The combination and number of patient diagnoses is then translated to a total RAF, which insurance companies use to determine the annual payment for the patient. You can view HCC RAF information during the point-of-care workflow, including diagnosis-level RAF weights and patient RAF scores, and using the HCC RAF GAP report.

Note: HCC diagnoses must be captured each 12-month calendar year to count toward risk adjustment for that year. All athenahealth HCC features reset on January 1 of each year because a patient's risk score is calculated over the course of a calendar year.

For more information, see Patient Risk Adjustment and the Patient Risk Dashboard.

Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress report

 

The Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress report measures how effectively your organization is recapturing chronic conditions under HCC risk adjustment for patients who have been seen this year. This report is similar to the Patient Risk Adjustment (HCC/RAF): Diagnosis Gaps report, but it includes all patients for whom a claim has been submitted in the current calendar year.

 

The summary views of the Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress report identify the following information by department, provider, provider specialty, or HCC description.

Note: This information pertains to patients for whom a diagnosis associated with an HCC was coded on a claim or in a clinical order in the past 3 calendar years.

• Potential diagnoses — Number of times that a patient was seen who had a diagnosis tied to a CMS HCC billed on a claim in the previous 3 calendar years.
• Total and percentage of diagnoses captured — A diagnosis was "captured" when a diagnosis in the same CMS HCC was billed on a claim in the current calendar year.
• Total and percentage of diagnoses missed — A diagnosis was "missed" when a diagnosis in the same CMS HCC was not billed on a claim in the current calendar year and the patient has been seen at least once.

The Patient Risk Adjustment (HCC/RAF): Re-diagnosis Progress report is intended primarily for managers who want to assess the rediagnosis rates of patients with HCC diagnoses across an organization. You may want to export the report results to a data analysis program such as Excel, where you can assess rediagnosis success relative to opportunity by payer, provider, department, and HCC condition.