HCC Assistant is an innovative EHR-integrated HCC risk adjustment platform which parses the patient chart in real time and suggests all HCC diagnoses that may have been overlooked during the patient encounter.
New! OCR of scanned documents and conversion to text for HCC analysis!
What is HCC
Hierarchical Condition Category (HCC) and Risk Adjustment is a payment model which identifies individuals with serious or chronic illness and assigns a risk factor score to them based on the individual’s health conditions and demographics. The risk adjustment score is then used by CMS to determine the payment to Medicare Advantage Plans. There are more than 9000 ICD-10 codes that map to 79 HCC categories in the HCC Risk Adjustment model. The submitted diagnoses and the plan of care related to the diagnoses must be documented in the patient chart by the health care provider at least once every calendar year in order to meet CMS guidelines.
What does HCC Assistant do
Real-time HCC Diagnosis Guidance
HCC assistant parses the patient chart and shows all possible HCC related diagnoses in real-time to the provider or the coder so that HCC opportunities are not missed while documenting the patient visit. Real time risk adjustment factor (RAF) scoring within the platform suggests how codes selected will impact the RAF score for a patient thereby predicting future funding and expenditures.
Integration in Provider’s Workflow
The HCC Assistant suggests possible HCC diagnoses while the provider is documenting the encounter or when the coder is reviewing the chart for accuracy. It can also suggest plan of care documentation for a diagnosis, which can be edited easily and then added to the plan section of the chart.
Standalone HCC Assistant
The standalone version of HCC Assistant allows users to copy paste any digital clinical document into the tool for analysis without requiring EHR integration. Within seconds the Assistant displays all possible HCC diagnoses and ICD- 10 codes with supporting plan of care documentation which can be easily copied and pasted back into the patient chart.
HCC Assistant has the ability to analyze text from uploaded pdf documents and tiff images using optical character recognition (OCR) technology. This allows you to analyze scanned or faxed lab documents, consults notes, hospital records etc to capture all possible HCC codes for a patient.
HCC Code Validation
The HCC Code Validation Tool analyzes the clinical note to validate diagnosis codes in the assessment section against MEAT criteria and gives a clear Pass and Fail result for those codes. Validation of the submitted codes is essential to making sure that the codes are accepted by the payers and keeps the provider in compliance.
Return on Investment
Accurate documentation of patient conditions is critical to predicting the risk and future cost of your Medicare Advantage patients. This graphical example shows the baseline RAF (risk adjustment factor) score for a 78 year old male and how the RAF score can be significantly raised through accurate documentation and capture of HCC codes, resulting in thousands of additional dollars in reimbursement.
|Risk adjustment factor (RAF)||RAF score||Expected annual expenditure and funding|
|Male 75 to 79 years old||1.062||$9,611|
|HCC 86, Acute myocardial infarction||0.282||$2,552|
|HCC 111, Chronic obstructive pulmonary disease||0.355||$3,213|
|HCC 137, Renal failure stage IV||0.230||$2,082|
Structured and unstructured data analysis against intelligent clinical rules
HCC Assistant is a cloud-based intelligent HCC coding and billing platform which is integrated with major EHRs. The platform utilizes advanced Natural Language Processing (NLP) to analyze unstructured data as well as utilizing standardized vocabularies to analyze structured data in the patient chart. The complex intelligent rules built into the Assistant allows it to find diagnoses that may have been overlooked and represent opportunities to improve the documentation in real time. Where available, write back integration enables one click submission of HCC ICD-10 codes and supporting plan of care documentation back into the patient chart.
Why Choose Us
- Only solution designed to give real time HCC coding guidance to providers and coders in their workflow
- Real-time analysis of patient chart and prospective RAF scoring at the encounter level
- Analysis of structured and unstructured data in EHR
- Suggests plan of care which can be edited and added to the patient’s chart
- OCR enables analysis of scanned documents attached to the patient’s record.
- HCC Code validation tool helps providers stay in compliance