HCC Coding Services: Achieve Accurate HCC Risk Adjustment Coding

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HCC Coding Services Achieve Accurate HCC Risk
Adjustment Coding
Hierarchical Condition Categories (HCC), a risk
adjustment model that has been around for years,
but has heightened visibility since Medicare
Advantage Plans started to require RAF scores for
reimbursement. Today ever commercial payer and
coding leader is the eye for the same. Risk
Adjustment 101 The Risk Adjustment model uses
a patients demographics which further diagnoses
to determine a risk score, which is a qualified
measure of how costly that patients treatment is
anticipated. Healthy patients who are
below-average Risk Adjustment Factor score from
the insurance premium are transferred from
healthy patients to patients with an
above-average RAF score. Under this payment
model, two patients within the same practice can
have a different payment rate. This is due to the
variety of factors which determines the amount of
risk/work involved to maintain the health of a
patient.
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HCC Coding Services Achieve Accurate HCC Risk
Adjustment Coding

• HCC Coding
• CMS uses HCC to compensate Medicare Advantage
  plans established on the health of their members.
  It compensates accurately for the anticipated
  cost expenditures of the patients by adjusting
  those payments based on demographic information
  as well as patient as their health status.
• The risk assessment information is centered on
  the diagnosis data drawn from claims and medical
  records collected by physician offices, hospital
  inpatient visits and in outpatient settings.
• Diseases and conditions are organized into body
  systems or similar disease processes. The top HCC
  categories include
• Asthma and pulmonary disease
• Diabetes
• Major depressive and bipolar disorders
• Congestive Heart Failure
• Specified heart arrhythmias

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HCC Coding Services Achieve Accurate HCC Risk
Adjustment Coding

• Breast and prostate cancer
• Rheumatoid arthritis
• Colorectal, breast, kidney
• This new risk adjustment identifies patients and
  establishes the financial allocation offered by
  CMS towards the twelve-monthly care of every
  patient.
• This new model is established on serious chronic
  health conditions. Physicians should thoroughly
  report on every patients risk adjustment
  diagnosis which is based on accurate medical
  record documentation.
• Every detailed diagnosis is used to determine the
  RAF, therefore the score derived is further used
  to calculate the reimbursements as well as to
  know the future cost associated with the
  patients treatment.
• The Bottom Line
• HCC coding is the great equalizer. Earlier
  before the rise of the risk adjustment model,
  reimbursement was based solely on demographic
  factors. Since costs are supposed to vary widely
  in patients, HCC risk adjustment coding can now
  be widely used to assess patients on the same
  scale.

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HCC Coding Services Achieve Accurate HCC Risk
Adjustment Coding
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