HCC Coding Tips

If you manage high-risk patients and work tirelessly to keep them healthy, you need to be properly reimbursed for your work. For this to happen, you need to use the correct hierarchical condition categories (HCC) codes or you may be underpaid or not paid at all if the services aren’t billed correctly.

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.


What Is HCC Coding?

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.


How to Enter HCC Codes Correctly

Proper HCC coding helps you streamline your billing processes to maximize your reimbursements. Here are some useful HCC coding tips to improve your coding experience:

Understand the HCC Coding System

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 not getting enough credit for your work. This system is primarily designed for healthcare providers under the Medicare Advantage plans.

The system helps to fine-tune reimbursement rates depending on the seriousness of the patient’s condition. Use this coding system to predict your future healthcare costs so that you can budget your resources accordingly and apply for the right reimbursement.

Use the Right Documentation

When you’re doing HCC coding, ensure that the documentation you have is correct. This documentation needs to come from healthcare providers, and the correct documentation minimizes the chance of costly errors occurring.

Additionally, ensure that the documentation you have is complete and detailed. It should support the conditions you are coding. It should also contain relevant details such as the patient’s medical history, existing medical conditions, treatment plans, and medications.

Use Precise Diagnosis Codes  

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.

Review and Update Documentation Routinely

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. 


Tools of the Trade

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!






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