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Audit Spreadsheet for Reviews of HCCs

Here’s an audit tool that compliance professionals at one health system developed to audit their hierarchical condition categories (HCCs). The audit was partly a response to Medicare Advantage plans auditing their HCCs (see story, p. 1).[1] “Up to this point, payers have reviewed our records in order to add HCCs,” said the compliance officer, who prefers not to be identified. “I have never seen the payers question the validity of a diagnosis until this month. Humana sent us two audits where they felt the HCCs were not supported. We agreed in some cases, but not in others.” The compliance professionals created one tab for every HCC they reviewed. Columns K through Q are the items that must be met. R is used if the initial note reviewed does not support the diagnosis. S through T provide additional information related to R, and U provides the feedback if a diagnosis is not supported. An important part of the audit is determining whether the diagnosis is supported by MEAT (monitoring, evaluating, assessing/addressing, treating) criteria.

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