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

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 patient’s 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.

https://www.247medicalbillingservices.com

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About 247 Medical Billing services

24/7 Medical Billing Services is the nation’s 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.