If your healthcare organization has Medicare patients that receive coverage and benefits through the Medicare Advantage (MA) program, you use hierarchical condition category (HCC) coding. The Centers for Medicare and Medicaid Services (CMS) established the HCC risk-adjustment model in 2004 in an effort to better predict healthcare costs for each and every patient–this model aims to increase the accuracy in risk-adjustment data for reimbursement claims.

The HCC model requires sorting through massive amounts of data in order to identify accurate codes and scores. However, making use of various datasets and sources can be challenging without the proper best practices or tools to support HCC diagnosis. Data extraction is only one piece of the puzzle, and everything from electronic health record (EHR) history to status post has a place in your codes. Still, assessing what is relevant can be overwhelming.

While you can add an HCC coding specialist to your team or educate your providers with continual HCC coding training, diagnosis suggestion tools from Inferscience can streamline your HCC coding practices. Inferscience offers high-quality HCC risk adjustment tools that provide solutions to physician groups, health systems, and healthcare payers. In this article, we’ll explore three of these tools: HCC Assistant, HCC Validator, and Ubiquity.

HCC Assistant

If your organization is looking for an HCC coding platform that integrates your EHR, the HCC Assistant may be the tool you need. The HCC Assistant quickly identifies prospective HCC codes for documentation in just a few clicks. In just three steps, you can add selected HCC codes to the patient’s assessment and plan.

Additionally, the HCC Assistant can allow coders in your organization to review and pre-select codes for the provider. That means providers can simply approve the pre-selected codes and document them in the EHR with the click of a button.

Key Features

With better HCC coding and risk adjustment documentation, your organization can see maximized reimbursements. A few key features that makes the HCC Assistant stand out include:

• Optical Character Recognition (OCR) analysis: The HCC Assistant analyzes text from your data source (typically uploaded PDF documents and images) using OCR technology. This allows providers to capture all possible HCC codes for their patients.

• Suggested Risk Assessment Factor (RAF) increase: The HCC Assistant displays real-time RAF-estimated scoring that reflects how the codes selected will impact the RAF score for a patient. This can predict future funding and expenditures.

• Integration in workflow: This tool suggests possible HCC diagnoses simultaneously as the provider documents the encounter, or when the coder reviews the chart for accuracy.

HCC Validator

If you need to optimize your coding accuracy, the HCC Validator analyzes clinical notes, validates diagnosis codes, and gives straightforward pass or fail results for said codes. This tool uses advanced Natural Language Processing (NLP) technology to instantly validate HCC codes against Monitoring, Evaluation, Assessment, Treatment (MEAT) criteria to issue the ‘pass’ or ‘fail’ grade instantly.

Key Features

With the HCC Validator, you can reduce audit risks and financial penalties because it takes the guesswork out of risk adjustment documentation. Here are a few other key features:

• The HCC Validator integrates seamlessly with leading EHRs and can also be used as a standalone solution.
• This tool provides insights into data sources and rule logic used to audit HCC codes.
• This advanced NLP technology instantly analyzes and audits all ICD-10 HCC diagnoses.

Ubiquity by Inferscience

Ubiquity is Inferscience’s own EHR agnostic tool that analyzes data in patients’ charts from any web-based EHR. It can show the HCC coding suggestions to providers in an intuitive, easy-to-read, expandable tab; this allows providers to submit HCC codes from the Ubiquity tab to the patient’s chart in the EHR.

Key Features

Ubiquity, along with Inferscience’s other signature tools and software, takes a holistic approach to external data. Inferscience does more than analyze the data in the EHR, we also access patient data from external sources, including lab and clinic results. Here are just a few more key features to seal the deal:

• Ubiquity automates HCC coding for providers without disrupting the workflow.
• Ubiquity eliminates the need for difficult system integrations while providing accurate risk capture and improved data accuracy.
• This tool provides robust reporting on providers’ engagement with Ubiquity and impact of its performance on risk adjustment coding.

Ready to integrate Inferscience’s software into your practice? Contact us today for your demo! At info@inferscience.com