Understanding HCC Coding and How It Impacts Risk Adjustment
Access to an appropriate Risk Adjustment Solution allows healthcare providers to optimize statistical information across the metadata and work on improving both retrospective and prospective processes. Such an efficient solution also assists in assuring precise and cost-effective compensation. In a Medicare Advantage (MA) or Affordable Care Act (ACA) system, a proactive Risk Adjustment Solution explicitly shows the participants' medical conditions, medical outcomes, and demographics. These are meticulously documented so that the health professional who manages those participants is adequately compensated for the management and reporting. As soon as MA Plans started mandating RAF rankings for fair incentives, Hierarchical Condition Categories (HCC), a Risk Adjustment (RA) method that has been around for quite some time, gained momentum. The Medicare plan is pressing healthcare companies for more valuebased efforts to reduce cumulative expenses and enhance care quality for Medicare users. Value-based prospective payment strategies have also resulted in cost savings for health insurance companies.
Interpretation of The HCC Coding System:
HCC Coding is used by the Centers for Medicare and Medicaid Services (CMS) to pay Medicare Advantage Plans based on the health of their subscribers. It correctly compensates patients for their potential costs by adjusting funds based on demographic variables and patient health status. The risk assessment analysis is based on diagnostic information acquired from claims and health data by medical clinics, inpatient and outpatient facilities, and clinical sites . The HCC is a diagnosis code category corresponding to ICD-9 / ICD-10 diagnosis codes. The HCC Code is determined using the CMS-accepted five diagnostic coding sources: 1. 2. 3. 4. 5.
Primary hospital inpatient Secondary hospital inpatient The outpatient Health professional Trained and licensed health worker
Accuracy Is the Name of The Game Clinicians and physicians must record each patient's risk adjustment assessment correctly under the CMS-HCC paradigm. In other words, the RAF is derived by each unique diagnosis, and the score is being used to determine the payer coverage and future cost for every patient. What is the purpose of the HCC Coding Solution? The HCC Coding Solution aids in the verification of a patient's HCC scoring position, which, when properly recorded, improves the patient demographic's overall RAF score and reflects premium payments. 2) It highlights patients with HCC Coding prospects in the local clinic. 3) It ensures that health professionals are paid the whole amount due for diagnosing and providing care.