Improve Revenue with HCC Coding
Hierarchical Condition Category (HCC) methodologies play a vital role in demonstrating illness complexity, assessing the health of populations, and reimbursement for healthcare services. HCC systems are designed to accurately predict risk by categorizing medical diagnoses into clinical conditions or groups of related conditions with varying degrees of severity or risk.
Providers bear more financial risk in a value-based healthcare system, underscoring the importance of demonstrating the complexity of the patient population being treated by documenting HCCs. Hierarchical Condition Categories are used to stratify risk and healthcare expenditures by commercial payers and Medicare for Medicare Advantage (MA) and the Medicare Shared Savings Program (MSSP).
The Medicare Advantage and Affordable Care Act (ACA) individual health insurance marketplace populations are both subject to risk adjustment and continue to expand, representing a sizable portion of insured beneficiaries in the U.S. More than half of eligible Medicare beneficiaries are currently enrolled in a Medicare Advantage plan.
This course provides an overview of important concepts related to HCC coding. Successful risk adjustment and payment reimbursement require accurate reporting and proper provider documentation of a patient's illness severity. Providers and coders must follow ICD-10-CM guidelines when selecting diagnosis codes for an encounter, and determine whether to use all current and past conditions. Special care should be taken with selecting specific diagnosis codes for chronic conditions. It is important to know what types of unspecified codes do not carry a risk-adjusted factor (RAF). Practices often neglect to report status codes, and failure to do so has negative consequences in risk-adjusted diagnosis coding. It is imperative to improve documentation to replace unspecified codes with more specific diagnosis codes.
Risk adjustment relies on the consistent and accurate redocumentation of a patient's conditions on an annual basis using ICD-10-CM codes. The risk score will not accurately characterize the patient's risk to the plan if the chronic condition is not recaptured. Provider documentation is crucial for supporting a patient's risk profile. Learn how to improve clinical documentation and avoid common HCC coding errors. Walk through examples of identifying specific conditions, assigning HCC codes, and calculating a RAF score. Version 28 made significant changes to the risk adjustment model used in the Medicare Advantage reimbursement system. Risk scores and HCC coding have a financial impact on healthcare providers. Gain actionable tactics to foster and sustain HCC coding quality and ensure regulatory compliance to prevent fraud and abuse. Successfully identify missed opportunities that could positively impact the practice's revenue cycle.
Medical coders, practice administrators, medical office managers, healthcare providers, and provider reimbursement related staff in practices participating in value-based payment programs, ACOs, and clinically integrated networks. This course will benefit anyone seeking to further their understanding and application of HCC coding concepts.
Continuing Education Units (CEUs)
Earn 3 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).
If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.
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Program Schedule
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