HCC Coding for CMS

HCC Coding for CMS

What is CMS?

We have all heard of CMS. CMS stands for the Centers of Medicare and Medicaid Services, which is the part of the Department of Health and Human Services (HHS). CMS was started in 1965 by President Lyndon B. Johnson, who signed into law the bill that lead to the creation of Medicare and Medicaid. The original Medicare program included Part A, which is the hospital insurance portion, and Part B, the medical insurance. Over the many years, Congress made changes to Medicare by making more people eligible for coverage. In 1972 Medicare was expanded to cover disabled people and people 65 years and older. Prescription drug coverage benefits were also included later on. Medicaid covers medical insurance for people who receive cash assistance for low-income families, pregnant women, people of all ages with disabilities, and people who need long-term care.

CMS Coding?

Since CMS covers the health and medical costs for all of these populations, it is important to ensure that there is a standard way to reimburse providers, health care institutions, and health care plans. Coding allows for proper group diagnoses and indicators for diagnoses on all reported claims for appropriate payments. CMS uses HCC coding as a way to standardize reimbursement and ensure quality care for patients who are receiving coverage from CMS. HCC stands for Hierarchical Condition Category, which is a risk-adjustment model designed to estimate future health care costs for patients for reimbursement. The CMS HCC model is used to predict the healthcare spending for Medicare Advantage Plan enrollees and was initially implemented by CMS in 2000.

How we can help

Without knowledgeable and experienced HCC coders, inaccurate coding can lead to inappropriate estimates in health care costs for patients leading to reduce reimbursements. If you work with our team at HCC Coders, our HCC coder experts understand accurate and reliable coding to ensure that you get maximum reimbursement from CMS. Our HCC coders are certified coders and experienced in medical record retrieval, prospective risk adjustment coding, physician chart audit processes and reports, and assistance with identification of opportunities for coding improvement and education. We have a network of certified coders that are available for in house use, where your organization can outsource the handling of all your coding activities and needs. Additionally, our team at HCC Coders have access to the latest proprietary software platform and IT technology. Give us a call at 877-328-2343 to get started to today and learn about how our services can help you. Don’t delay!