HCC Risk Adjustment Coding


You may have heard of HCC risk adjustment coding. This coding method is used to identify high-risk patients based on chronic health conditions in the healthcare industry. It can help you save revenue by categorizing patients with severe health conditions. Here’s how it works. Read on to learn more. Getting started with HCC Risk Adjustment Coding is easy and free. 

HCC risk adjustment coding

When it comes to health plans, the accuracy of medical records is of paramount importance. Correct HCC coding is vital to their ability to reimburse providers adequately. In addition, it directly impacts the quality of care, revenue, and financial resources. Over 100 million medical records are reviewed in the United States alone. To ensure that accurate HCC coding is consistently applied, healthcare organizations are constantly looking for new ways to achieve accuracy. The Hierarchical Condition Category (HCC) model explains this coding process.

The traditional method of HCC risk adjustment coding is incredibly inefficient and resource-intensive. It requires coding specialists to scour massive medical records, which increases the chances of human error. In addition, missed HCC risk codes cost health plans millions of dollars every year. The inefficiencies of this process are estimated to cost companies as much as 20-30 percent of their revenue each year. HCC risk adjustment coding should be performed by highly trained personnel and backed by an excellent technological solution to avoid these potential errors.

HCC is based on severe or chronic health conditions.

Healthcare providers must use HCC coding to identify each patient’s severe or chronic health conditions to receive reimbursement. Physicians must thoroughly document each risk adjustment diagnosis, supported by documentation in the patient’s clinical medical records. The diagnosis must be specific enough to predict future healthcare costs and impact a patient’s care, regardless of how minor or severe the condition. Inaccurate diagnoses can negatively affect patient care, resulting in reduced reimbursement.

The HCC coding model assigns an RAF to each patient based on the number of severe or chronic health conditions they have. The RAF is a measurement of the probable cost of a patient’s care and is used by insurers to adjust the Medicare Advantage capitation payments. According to the American Academy of Family Physicians, accurate HCC coding is critical for communicating patient complexity, painting the picture of the patient, and measuring quality performance. Therefore, HCC coding can significantly impact a healthcare organization’s financial viability and quality of care.

HCC is easy to use

Correct diagnosis coding is critical for determining HCC risk adjustment and ensuring that providers receive appropriate reimbursement for their services. Coding to the highest level of specificity is an easy and best practice, but Electronic Health Records (EMRs) complicate the process. In this EMRs, unspecified codes often appear at the top of the diagnosis list. To overcome this challenge, create a list of favorite HCC diagnoses that map to HCC scores.

To maximize your productivity, use HCC Coder. HCC Coder is intuitive, moving you step-by-step through the coding process, and it is the tool that eliminates irrelevant information and saves time for the IT department. This software will help you code better and save money by streamlining your work process. It will also improve your productivity and efficiency as designed for medical coders. So, take advantage of HCC coding software and boost your productivity!

HCC helps save revenue.

CMS’s HCC risk adjustment coding model helps healthcare organizations predict resource use by Medicare Advantage enrollees. The risk model looks at prospective data and predetermines the cost of each patient for the following year. These calculations help healthcare organizations set the appropriate reimbursement for physicians. This risk model was first implemented in 2004 and has become more prevalent as value-based payment models gain popularity. If you’d like to learn more about how HCC risk adjustment coding helps save revenue, contact YES HIM Consulting, Inc.

The benefits of HCC risk adjustment coding are many. 

First, it helps hospitals capture patient conditions. Second, HCCs allow health plans to predict costs by stratifying patients’ risks. For example, hospitals must include HCC codes as part of their professional services to maximize payments under capitated payment arrangements. When HCCs are omitted, hospitals are deprived of compensation while failing to picture patient conditions’ severity accurately.

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