If you manage high-risk patients and work tirelessly to keep them healthy, you need to use the correct hierarchical condition categories (HCC) codes – and ensure your documentation of them is flawless. This is essential to ensure you are properly reimbursed for your work.
Incorrect HCC coding can lead to payment delays and denials for the services you provide. As a healthcare provider, you and your office staff need to be familiar with the latest HCC coding software and techniques to ensure that you’re always reimbursed fully for your hard work.
With the right coding tool, you can easily and correctly determine the costs of providing care for your patients who have greater medical needs and the amount you’ll be paid by the insurance companies.
This article will help you understand the nitty-gritty of HCC coding and how to do it correctly.
HCC coding is the process of adjusting the risk involved in taking care of a patient to estimate the patient’s future healthcare costs. This risk-adjustment model was developed in 2004 and has become the standard for risk adjustment in the medical field, especially now that the industry is rapidly shifting to value-based reimbursement models.
This coding is essential for communicating patient complexities and providing practical insights into the patients you’re dealing with. The model helps predict your future healthcare resource needs and utilization; it provides you with risk adjustment factor scores that you can use to adjust the healthcare you provide.
As a healthcare professional taking care of high-risk patients, you can’t afford to ignore the basics of the HCC coding system. Doing so comes with hefty consequences that include:
When you’re doing HCC coding, accurate documentation is crucial. There are several reasons why:
Providers are required by the CMS HCC documentation guidelines to record all conditions they evaluate during face-to-face patient interactions. You should aim to eliminate gaps in every patient’s medical history, documenting existing medical conditions, treatment plans, and medications in a clear and accessible manner.
Always use specific diagnosis codes that correctly mirror the patient’s current and previous medical conditions. The codes must have all pertinent details included in the documentation. Wrong diagnosis codes will lead to inaccurate HCC coding or missed HCC codes.
Because the HCC coding system is dynamic and updated regularly, you also need to regularly analyze and update your documentation to maintain consistency and accuracy. This includes reviewing your patient’s current medical condition and prognosis, as well as their medical history. This way, you can identify gaps in the patient’s documentation and ensure you’re getting the appropriate reimbursement for your services.
New technologies aimed at streamlining the HCC coding process and documentation have been developed, allowing healthcare providers to complete their coding more quickly and without errors.
For example, you can use Inferscience’s software to analyze your patient’s documentation from their electronic health record and get accurate HCC coding suggestions in a readable and expandable tab. This technology smooths out the HCC coding process, minimizing costly errors and ensuring that your final coding gets you the greatest amount of reimbursement possible.
You can also use new technologies to obtain real-time feedback to further reduce the risk of inaccurate coding. Inferscience has the technology you need to streamline your HCC coding–reach out today for your free demo!
