Hierarchical Condition Categories (HCCs) are a hot topic in health care today, and there is no better time to examine the usefulness of HCC coding program! HCC coding is the risk adjustment method utilized by the Centers for Medicare and Medicaid Services to estimate annual payments for Medicare Advantage beneficiaries. HCC risk adjustment employs predictive modeling to estimate the severity of patients’ diseases, health risk, and status in order to estimate the cost of health care coverage for that demographic. This is how CMS calculates cost savings for patients enrolled in Accountable Care Organizations and the Independence at Home Medicare Demonstration. HCC risk adjustment will also decide which Practice Risk Group patients will be assigned to the new primary care first model. The HCC model was launched in 2004, but it is becoming more popular as the healthcare industry transitions to value-based payment models.

HCC Risk Adjustment values vary by beneficiary demographics, RA model, and specificity of the reported diagnosis, and they alter from year to year. Unspecified diagnosis code ranges are utilized throughout this resource as a guideline for you to determine the right specified code based on your patient’s conditions. For community non-dual aged beneficiaries, the HCC values mentioned are based on the 2020 CMS Alternative Payment Condition Count Model also popularly known as 2020 CMS; HCC model. Risk adjustment may differ based on the clinical situation and its approach meant to predict and estimate the future healthcare cost for patients. To assign risk scores to patients, the hierarchical condition category uses ICD-10 coding. Each HCC is assigned an ICD-10 code. A patient with few major health concerns could be expected to have typical medical costs for a particular time period. A patient with several chronic diseases, on the other hand, is likely to have higher health-care utilization and costs.

Erendiz Academy and HCC Course Training:

Correct diagnosis coding is always important, and it stands critical for proper risk adjustment as it promotes appropriate provider reimbursement in the value-based payments environments. Always code to the maximum specificity is a simple “best practice” to implement. Enrolling with Erendiz Academy’s training you will gain complete knowledge of HCC coding and will be capable of understanding which conditions are of risk adjustment will assist your practice in improving diagnosis coding accuracy and reflecting the severity of the condition. Getting trained in HCC coding will make you expert in reading a medical chart and assign the correct diagnosis codes for a wide range of clinical cases and services for risk adjustment models such as hierarchical condition categories (HCCs), Chronic Illness and Disability Payment System (CDPS), and U. S. Health Department and Human Services risk adjustment. Examine and assign proper medical codes for diagnoses performed in the office or facility setting by physicians and other authorized healthcare providers.

Understand medical coding norms and regulations in depth, including compliance and reimbursement, as well as the influence of diagnosis coding on risk adjustment payment models.

Understand the risk adjustment model audit procedure.

Identify and present documentation flaws to providers in order to enhance documentation and ensure appropriate risk adjustment coding.

How do Medical Coders employ the HCC coding model?:

HCC crosswalks are relatively simple to utilize, and medical coders that work with HCC coding models and risk adjustment can obtain the data in a variety of ways. For example, a coder may determine the ICD-10-CM code for the encounter from the medical record and then look for that code on the crosswalk if utilizing the HCC spreadsheet. Many companies will provide an HCC add-on if the developer uses coding tools. The ailment category is indicated with the ICD-10-CM code if the condition is HCC-relevant. If the disease is not related to HCC, the ICD-10-CM code will not appear on the crosswalk (and will not be flagged in the coding software as having an HCC value.) This is not to say that the coder should not work.

Mode of Training

• Online
• Classroom