Closing HCC Coding Gaps

Proper hierarchical condition category (HCC) coding is crucial to paint the full picture of a patient’s health, particularly concerning the long-term complexity of treatments they’ll need for certain diagnoses.

But many providers struggle with gaps in their HCC coding – leading to unoptimized risk adjustment factor (RAF) scores, less effective patient care, and missed Medicare Advantage funding.

This article explores the most common methods to avoid errors in your HCC coding – and reveals one solution that can close these gaps and increase your RAF scores by an average of 35%.

 

Four Ways to Avoid HCC Coding Errors

1. Practice Better Documentation

When healthcare providers create complete, precise records with a full log of all procedures, conditions, complications, comorbidities, diagnoses, and interventions, there is less potential for an HCC code to be missed or misreported.

Best practices here include:

  • Collecting and aggregating data at all points
  • Using forms such as patient assessment forms (PAFs) or comprehensive health assessments (CHAs) to help collect more complete diagnoses at the point of care

 

2. Emphasize Coding Specificity

There used to be 19 different categories of HCC codes and 86 HCC codes. But changes enacted in 2024 mean there are now 115 different payment HCCs – which puts pressure on providers to ensure maximum precision in their coding.

Every provider should ensure their physicians are aware of these changes and take measures to be extra specific when documenting diagnoses – to ensure they assign the right values and accurately determine risks.

 

3. Revalidate Data Regularly

Chronic conditions must be documented every year to be factored into risk adjustment calculations. But many providers fail to revalidate data – which can lead to inaccurate HCC coding.

Follow-ups must be made to keep track of any patient’s health conditions and those who don’t get to visit their physicians annually should be flagged so that annual wellness check-ups can be scheduled.

 

4. Educate Your Teams

Well-trained HCC coders can identify and intercept issues and omissions before they have an impact, ensuring that the calculated risk score documented by Medicare or a relevant payer is accurate and aligns with anticipated patient care expenditures. But many providers lack the time or resources to offer their staff adequate education.

Overcoming these constraints to offer coding training can dramatically reduce human error. This could be supplemented if necessary by hiring extra staff – such professional HCC coders or care coordinators.

 

What is the Best Solution to Improve HCC Coding?

While every solution discussed above can help reduce HCC coding gaps, many are either difficult to instantiate or unreliable. Human error is a major cause of HCC coding errors and simply encouraging your staff to be more specific or improve their documentation process is unlikely to be a sustainable solution to the problem of HCC coding gaps.

Instead, there is really only one way to ensure your gaps are closed – and that is by solving the problem with technology.

Inferscience’s HCC Assistant is an EHR-integrated HCC coding platform that increases the average provider’s RAF score by 35%. It uses natural-language processing (NLP) to analyze structured and unstructured data in a patient’s medical chart and leverage complex rules to find diagnoses that may have been overlooked – before displaying them as recommended HCC codes in real-time.

For physicians, this makes life simple and gives them more time to focus on patient care.

You simply:

  • Open the patient’s chart and let the HCC risk adjustment app automatically analyze the clinical information
  • Review the suggested HCC codes
  • Select the codes you want to document
  • Click “submit to add selected HCC codes to your assessment

 

As a result, you can:

  • Automate the review process: Save hours of work revalidating and reviewing data manual
  • Practice better documentation: Users can accurately capture and analyze data with minimized error
  • Remove the need for extra staff: The speed and accuracy of the HCC Assistant means you don’t need to hire extra coders or care coordinators to manage the growing workload
  • Increase your RAF scores: The HCC Assistant increases the average provider’s RAF score by 35%

 

All with a single easy-to-implement solution.

Want to see it in action?

Book a Demo

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