<img height="1" width="1" style="display:none;" alt="" src="https://dc.ads.linkedin.com/collect/?pid=455513&amp;fmt=gif">

Shifting to Value-Based Payment Models with SDoH Z Codes

Posted By Marie Thomas

The time is here to prepare for a value-based care environment. To achieve this goal, it is vital to ensure the patient population you serve is truly reflected in your data. Particular attention must be paid to documentation specificity and code assignment, capturing acute and chronic conditions, and to risks that impact the patient and social determinants of health that we know do pose a threat to a patient’s health. In 2021, we have the capability through ICD-10 CM diagnosis codes Z55- thru Z65- to capture, monitor, and manage social factors that cause a variety of health impediments.

Transitioning from fee-for-service into a value-based care payment environment requires participation from all levels of care from primary to specialty and inpatient to outpatient. One size does not fit all, so it is important to assess your data and make sure it best represents your practice and healthcare population. The data tells the story.

In today's healthcare field, analyzing conditions on a targeted, case-by-case basis is exposing factors that can best be addressed by social services, case management, and clinicians. Focusing on key, managed care chronic conditions like Congestive Heart Failure (CHF), Chronic obstructive pulmonary disease (COPD), and Diabetes, helps to reduce the need for readmission, the overutilization of resources, missed appointments, and inflated lengths of stay.

A value-based approach calls into question the effectiveness of the standard practices when encouraging patient involvement in their health care. Does the patient clearly understand the clinical content provided in a discharge plan? And, most importantly, can they implement the discharge plan outlined? Does the patient have the means to get and take their medications as prescribed, and can they engage in the preventative measures required? If they do not, these red flags are worth noting with a descriptive Z Code to steer the process towards a better quality outcome. A practice guideline we shared in our most recent webinar is - Ask, Document, Code, Report – when addressing SDOH in 2021.

Healthcare organizations and government entities are focusing more strongly than ever on closing the quality gap for the most vulnerable populations in our country. To meet the challenge, Value-Based Care initiatives are rapidly growing year by year. Healthcare systems embracing this movement have the dual benefit of ensuring better health outcomes for the vulnerable while securing their own revenue cycle through risk reduction ROI.

Social Determinants of Health, a catalyst for both poor patient outcomes and revenue cycle leaks, are subtle risk factors that can elude standard information-gathering procedures. Further complicating the process, it can be difficult or uncomfortable to gather such sensitive life data from patients. Nevertheless, the risks are present and identifiable.

It is our responsibility as healthcare professionals to capture and account for these subtle indicators that have a profound impact on patient health. The most effective way to ensure gap closure and to produce better quality outcomes is to regularly audit and optimize your SDoH documentation and coding processes so that vital information is not left undiscovered and necessary Z Codes are not left uncoded.

ECLAT medical coding solutions’ team of audit and coding professionals are experts in SDoH capture, coding, and policies. Partner with us to secure your revenue cycle’s future and your patients from vulnerabilities today as healthcare shifts to a Value-Based Care environment.

Request a Third-Party Audit


Tags: Medical Coding, ICD-10 auditing, value-based care, SDOH, medical coding solutions