HCC Coding
CMS updated the 2024 CMS-HCC risk adjustment model by including reliable predictors of future costs and excluding unreliable ones. In summary, the CY2024 CMS-HCC model classifies the ~74,000 ICD-10-CM diagnoses codes into 266 CMS-HCCs.
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Times of frequent medical coding updates have highlighted the necessity of medical coding consultants, or coding subject matter experts (SMEs), to help healthcare providers navigate such changes.
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Every year, the Centers for Medicare & Medicaid Services (CMS), and the American Medical Association (AMA) release updated coding and reporting guidelines that make additions, deletions, and revisions to the ICD-10 and HCPCS code sets, and CPT codes, respectively. During Public Health Emergencies (PHE), such as the COVID-19 pandemic, CMS and AMA will release updates more frequently. By offering ongoing medical coding training to cover these annual updates, your coding team upholds an accuracy standard and stays compliant with these revised guidelines. YES Education offers a robust catalog of medical coding updates that refreshes as the code set revisions are released, including annual updates for ICD-10-CM/PCS and CPT.
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Several recent lawsuits have brought to light a list of risk adjustment schemes to increase reimbursements in violation of the False Claims Act. Here are some HCC coding 101 best practices to help your organization avoid scrutiny.
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What is HCC coding used for? Why is HCC coding important? This brief article will touch on the questions above and explore how a recent YES HCC consulting case study highlights the importance of HCC coding in healthcare.
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Reducing your risk of inaccurate HCC coding and compliance issues begins with an efficient HCC auditing partner. An external HCC auditing consultant, like YES HIM Consulting, can conduct regular coding audits to identify issues before they are flagged.
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The cost of inaccurate HCC medical coding is detrimental to an organization’s bottom line. Without a true assessment of the patient’s care, the hospital’s reimbursement is lower, leaving money on the table.
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There are two different Hierarchical Condition Category (HCC) models used to calculate risk adjustments: the CMS-HCC model and the HHS-HCC model. Does your facility know how and when to use them? Our detailed HCC risk adjustment infographic explains the differences and usages for each HCC model.
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Outsourcing no longer means time-zone hopping overseas to find reliable, skilled, and affordable medical coding and auditing companies dedicated to achieving high coding productivity and quality standards. It is increasingly common for healthcare organizations to outsource coding overflow and quarterly audits by sourcing talent from a U.S.-based company. YES HIM Consulting is proud to be a premier coding, auditing, and education preferred partner to large-scale healthcare systems, individual hospitals, physician groups, and more around the U.S.
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CMS has released Part 1 of the 2022 Medicare Advantage Advance Notice, which reviews the updates to the Part C CMS-HCC risk adjustment model and the application of encounter data (CMS, 2020). Changes to the CMS Advance Notice are scheduled to be finalized by April 5, 2021. HCC coding and risk adjustments are one of YES HIM Consulting’s many specialties. The Risk Adjustments & HCC Basics learning path from YES HIM Education provides an overview of the HHS and CMS risk adjustment models, documentation, coding practices, and much more.
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