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Best Practices of HCC (Hierarchical Condition Categories) Medicare Advantage Risk Adjustment

Posted By Giovanna Stahl
hcc coding

It seems that more and more physicians are not quite aware of how crucial accurate and compliant hierarchical condition category (HCC) coding is to their healthcare organization. HCC coding allows for various payment models to fairly determine services and costs that a patient receives. However, as not all HCC codes are linked together with ICD-10-CM codes, it is still important to understand HCC and which specific conditions are linked to it, as it will allow them to obtain complete information and maintain the accuracy that’s necessary for a patient to receive affordable and quality healthcare.

At ECLAT Health Solutions, our ICD-10 coding specialists have a strong foundation in the ICD-10-CM Official Guidelines for Coding and Report for FY 2019 and are able to implement accurate coding into the health systems of hospitals, clinics, and other healthcare organizations. Our staff is highly trained and certified, working around the clock to ensure that you receive medical coding services that are always up to date. We provide this through our reliable ICD-10 auditing, clinical documentation improvement (CDI), as well as medical coding and billing optimization services. Below, we discuss the essential concept of HCC coding and why it is important for it to maintain accuracy and compliance:

What is Hierarchical Condition Category (HCC) Coding?

This risk-adjustment model is designed to estimate future healthcare costs for patients based on demographics – age, gender, Medicaid eligibility, and living conditions – and the severity of their condition. While the Centers for Medicare & Medicaid Services (CMS) developed an HCC model to expand prominent environment shifts to models that were value-based on payments, the HCC became highly reliant on accurate ICD-10 coding to pair a specific risk score to the specified patient.

Considering that every HCC is connected to an ICD-10 code and the different demographic factors, an insurance provider will utilize HCC coding and designate a patient’s risk adjustment factor (RAF) score. In terms of a patient that is experiencing serious health conditions, they would be expected to accrue an average amount of medical costs for a certain period of time.

What Makes HCC Coding Important?

Simplifies Communication

Since hierarchical condition category coding is organized in a way that captures a patient’s complex situation or severe condition, it provides clarity to how the health organization’s services are measured and allow for ICD-10 coding specialists and insurance companies to efficiently communicate and work together.  

Quality & Costs Are Appropriately Measured

While we know there is a difference in patient complexity, quality and cost performance is more easily calculated because HCC coding exists and is fully functional. As ICD-10 coders are aware that accurate coding assigns a weight to more complex conditions, this combined with the demographic (age, sex, and Medicare/Medicaid eligibility) allows them to determines the appropriate HCC score.  

Receive Expert ICD-10 Auditing Services From ECLAT Health Solutions

Accurate and compliant hierarchical condition category (HCC) coding is integral to maintaining the integrity of your healthcare organization, as these facilities strive to work toward an improved patient-care experience that’s based on a pay-for-performance model rather than fee-for-service. As accurate and compliant HCC coding helps predetermine a patient’s healthcare utilization and cost, it can also accurately measure your organization’s efficiency and quality of care. If you see that your organization needs assistance with improving your claim and coding process, consider partnering with us to experience the ECLAT difference so that your patients can receive a higher quality of care at a lower cost.

At ECLAT Health Solutions, our ICD-10 specialists are masters in HCC best practices while improving numerous coding and billing systems of many medical institutions, from hospitals to independent practices and clinics. Our coding specialists are certified experts in a variety of code forms, from ICD-10, CPT4/HCPCS, and many more. We perform medical coding and billing, excellent ICD-10 auditing services, clinical documentation improvement, and can help reshape your health system into one that is more efficient.

Experience the ECLAT Health Solutions Difference today! Get in touch with our ICD-10 coding experts and fill out our form.

Tags: ICD-10, HCC