HCC (Hierarchical Risk Adjustment) – A Key To Coding & Care

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HCC (Hierarchical Risk Adjustment) A Key To
Coding Care  

• The methodology used by various governments and
  payers to adjust revenue based on the diversified
  health status of the covered population is known
  as risk adjustment. There are numerous advantages
  to HCC Risk Adjustment, including adequate
  funding, aligning incentives with rewards (the
  triple aim outcomes), and optimizing quality and
  efficiency.
• HCC Review is the process of extracting insights
  from voluminous data to identify coding gaps or
  errors that result in an inaccurate assessment of
  the patients clinical profile. In other words,
  it can be defined as the process of ensuring that
  the clinical condition complexity of patient
  segments is as accurately documented as possible.

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Cardinal Rules of HCC Coding

• There are some fundamental rules for coding
  patient data that serve as a baseline for the
  initial HCC review
• Documentation of existing conditions A review
  determines whether the condition is correctly
  coded or whether the coded condition exists.
• Diagnoses are episodic and do not carry over from
  one visit to the next A patient with a missing
  limb must be recoded again within the next year,
  or the system will believe the patient grew a
  limb.
• Multiple times coding For relevance, accuracy,
  and recency, the exact condition can be coded
  multiple times.
• Other rules Co-existing conditions provide a
  complete picture of the patient and should be
  coded together.

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HCC Review Types

• The following are the different types of HCC
  review processes that the providers can follow to
  ensure HCC coding accuracy and submission of
  clean claims
• Prospective Review It assists providers in
  preparing for scheduled/upcoming patient
  encounters.
• Concurrent Review Like real-time review, HCC
  coders assess the patient chart, clinical notes,
  and HCC codes before submitting claims to payers
  but with some lag. Emerging technology may enable
  concurrent review in real-time.
• Retrospective Review This type of review is
  usually performed several weeks or months after
  the patient encounter and claims submission
  process has been completed. The goal is to
  conduct a post-audit and potentially uncover
  unreported and incorrectly reported HCC codes.
• Best Alternative You can combine prospective and
  concurrent reviews to ensure accurate
  documentation and claims. Prospective review is a
  good practice as it allows providers to take full
  advantage of the upcoming patient encounter and
  the right at the first accuracy of their
  prospective claims.

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Why is HCC Coding Important?

• Correct diagnosis coding is indeed essential, but
  it is vital for accurate risk adjustment as it
  drives appropriate provider reimbursement in
  value-based payments. Always coding to the
  highest specificity is a simple best practice
  to implement. Unfortunately, Electronic Health
  Records (EHRs) make this more difficult because
  the search list for diagnosis codes frequently
  places unspecified codes at the top of the list.
  To overcome this obstacle, the best strategy is
  to approach 24/7 Medical Billing Services working
  as a team of professional HCC coders with the
  updated information and regulations.

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About 247 Medical Billing services
24/7 Medical Billing Services is the nations
leading medical billing service provider catering
services to more than 43 specialties across the
entire 50 states. You can rely on us for
end-to-end revenue cycle management. We guarantee
up to 10-20 increase in the revenue with cost
reduction of your practice for up to 50. Call
us today at 888-502-0537 to know more on how we
can help boost profitability for your practice.
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Call us Today
Media Contact 24/7 Medical Billing
Services, 28405 Osborn Road, Cleveland, OH,
44140 Tel [phone] Email
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