Best Practices for HCC, E/M, and Interoperability
- Predictable reimbursement depends on three pillars: accurate HCC capture, defensible E/M documentation, and reliable system interoperability working together.
- Strong HCC practices start with precise documentation and disciplined coding, including annual recapture of chronic conditions, specificity in diagnoses, and regular audits of high-value HCCs.
- E/M accuracy requires payer-aware documentation, with clear support for either MDM or time-based coding and safeguards against template overuse and weak clinical linkage.
- Interoperability directly affects coding accuracy, as clean data exchange (problem lists, medications, CCDs) ensures coders see the full clinical picture.
- Ongoing audits, governance, and feedback loops prevent revenue leakage, identifying documentation gaps, coding errors, and interface issues before they trigger denials or audits.
- Sustainable compliance is built through repeatable habits, not one-time fixes—using clear KPIs, compliant queries, and targeted EHR prompts to drive continuous improvement.