How to Improve Medicare Risk Adjustment Scores

As enrollment in Medicare Advantage plans grows, healthcare organizations need to be able to predict future healthcare financial resources and appropriate reimbursement. The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to estimate predicted costs for Medicare Advantage beneficiaries, and the results directly impact the reimbursement healthcare organizations receive.

CMS uses the CMS–hierarchical condition category (CMS– HCC) model to risk adjust MA payments. This model uses beneficiaries’ demographic information and diagnosed medical conditions gathered into hierarchical condition categories (HCCs) to predict their costliness. Many organizations today struggle to achieve optimal documentation that will help them increase RAF scores and funding from medicare advantage contracts. Having a successful strategy implemented to improve HCC medicare risk adjustment scores for your practice can help reduce underpayments, enhance the quality of care and improve funding.

The infographic guide below presents relevant data and HCC coding best practices to help you improve HCC medicare risk adjustment scores.

It is important to highlight the importance of using HCC coding technology to make documentation easier and help improve patients’ RAF scores.

Inferscience’s HCC coding application helps providers optimize HCC coding and risk adjustment documentation. 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 HCC Assistant allow 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 supports the plan of care documentation back into the patient chart.

If you’re a healthcare provider looking for HCC Coding technology tools you can visit our website at or contact us at 617 848 9502.

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