What’s the Big Deal With HCC Coding?

What's the Big Deal With HCC Coding?

If you are wondering what the big deal with HCC coding is, HCC Coders is here to help. Keep reading to learn more about HCC coding and how HCC Coders can help make the process easier for you.

What is HCC coding?

HCC coding is a way for the CMS to reimburse Medicare Advantage plans based on the care that their members receive. This model is a coding model that pays accurately for the predicted cost and expenses of patients. It is also adjusted for demographics and health status so it can serve as more of a one-size-fits-all type of payment model. HCCs are great for predicting resource use by Medicare Advantage enrollees and over time are also expected to become the model for commercial payers as well.

How does HCC coding work?

Under HCCs, diseases and conditions are categorized into body systems or similar disease processes. The main HCC categories include:

  • Major depressive and bipolar disorders
  • Asthma and pulmonary disease
  • Diabetes
  • Specified heart arrhythmias
  • Congestive Heart Failure
  • Breast and prostate cancer
  • Rheumatoid arthritis
  • Colorectal, breast, kidney

In many cases, patients are assigned to more than one category because the combination of demographic information and risk factors can represent more than one illness or potential for illness.

Specificity is key with HCC coding

In order for HCCs to work, physicians must thoroughly report on each patient’s risk adjustment diagnosis and the diagnosis must be based on clinical medical record documentation that results from a face-to-face encounter.

If you need help with your HCC coding, contact HCC coders today!

At HCC Coders, our goal is to assist health plan providers with capturing their full reimbursements from Medicare Advantage. We have over 28 years of experience and our network of certified coders can assist with your HCC coding tasks, including:

  • Medical record retrieval services
  • Access to HCC coding software
  • Complete, outsourced handling of all coding activities
  • In-depth, focused Retrospective Chart Reviews
  • Validation of ICD 10 diagnosis codes with medical records
  • Highlighting of any key coding or documentation errors or omissions
  • Inclusion of Part C and Part D coding in HCC data capture
  • Concurrent coding
  • Prospective risk adjustment coding
  • Physician Chart Audit summary reports
  • Identification of opportunities for coding improvement and education

If you need help with your HCC coding work, contact us at 877-328-2343 or info@datafied.com to learn more!

To learn more about the reliable and quality HCC coding services that we offer, visit us on the web at HCC coding.