Hierarchical Condition Category coding, alternatively referred to as HCC medical coding, is a payment strategy approvedby CMS (Centers for Medicare and Medicaid Services). This strategy is meant to identify persons suffering from severe and chronic diseases. They assign a risk factor score dependent on several factors. These factors include demographic details and a person’s health conditions. The Medicare advantage program utilizes diagnostic code as the primary indicator of an individual’s health status.
For some time now, Medicare has been using the HCC strategy to determine health plans and providers’ payments. Accurate Medicare Advantage coding plans lead to uncorrupted claims for medical practices. Busy practitioners deserve to get a higher return on investment. However, that’s only possible if they hire an experienced HCC Risk Adjustment Coding services provider. Experts with in-depth knowledge of medical billing offer extensive risk assessment, thereby submitting accurate claims. All this is done to provide top-notch patient care.
Understanding HCC Risk Adjustment Coding
The highest percentage of doctors are well-informed about new payment models such as bundled payment, accountable care organization, plus value-based purchasing that tends to transfer financial hitches to providers. Unfortunately, several physicians do not understand how vital accurate coding is under such models. Proper coding promotes shared savings, characterizes risks, and encourages the physician to offer patient-oriented care. Keep reading to understand better the HCC risk adjustment method’s process and its effect on your practice.
Hospitals and health system bosses decide on physician payments depending on how their system operates in value-based care. In such a case, risk adjustment tends to influence physicians’ income. Therefore, it’s necessary that you understand everything.
Shifting Risk Environment
The risk-bearing concept has been around for decades. However, Medicare Advantage gets capped per person monthly payments, hence bearing the financial risk for the beneficiary’s accumulative cost of care. But MA plans are usually offered by skilled commercial insurers who can influence geography, benefit design, and enrollment to have a financial breakthrough in risk management.
At times, organizations such as the Medicare Shared Savings Program and ACOs shoulder the risk without reaping the benefits of MA plans still under similar risk-adjustment techniques. Risk adjustment involves amending benchmarks and payments to reveal the state of an individual’s illness. That way, Centers for Medicare and Medicaid Services can easily approximate future spending. Also, providers get to understand their managed population health characteristics. In MSSP ACOs and MA plans, risk adjustment strategy is termed HCCs (Hierarchical Condition Categories).
MA plans have managed to leverage HCC strategy with notable financial success; hence providers should be keen. Understanding HCCs is essential as it reveals the state of a patient’s health plus the future cost. CMS uses such data to determine expenditure PMPMs or benchmarks. Such information is relevant to ACOs as it enables them to avoid shared loss and instead earn shared savings. This whole process’s main goal is to offer patients a first-class service at an affordable rate, concurrently ensuring that providers are accountable for everything.