Coding awareness critical to success in ‘new world order’ of value-based health care

SAN DIEGO — During her presentation at the United Rheumatology National Meeting, Gloria Johnston, MBA, RN, RHIT, Chief Health Information Officer of HealthAdvanta, highlighted why it is important for independent rheumatologists to be mindful of Hierarchical Condition Category coding as CMS continues to move from a fee-for-service to value-based health care model.

“The presentation on hierarchical coding categories touched base on what rheumatologists need to do to prepare themselves and their practice for this new world order,” Johnston told Healio Rheumatology. “We also provided some examples of how rheumatologists can capture the information necessary in the EHR to support the additional ICD codes that translate into Hierarchical coding categories.”

“Why this is important for rheumatologist is that rheumatology is a very expensive specialty and we provide very expensive treatment protocols for our patients,” Johnston said. “As such, we will be perceived by Medicare and other payers to be a high cost provider. Without explaining to those payers and CMS that our patients are very complex and have multiple chronic conditions in many cases, we could be at a disadvantage under that value-based program.”