Implement These Best Practices to Improve HCC Coding

Implement These Best Practices to Improve HCC Coding

Every healthcare organization that has Medicare patients who receive coverage and benefits through the Medicare Advantage program uses HCC coding. CMS established the HCC risk-adjustment model in 2004 to better predict healthcare costs for every patient and increase the accuracy in risk adjustment data for reimbursement claims (CMS, 2004). But, what is HCC medical coding?

Hierarchical condition category (HCC) medical coding utilizes the ICD-10 code set. This is used to identify risks for each patient and assign risk values, or RAF scores, in value-based care models. In addition, coding an accurate RAF score directly impacts Medicare beneficiaries’ coverage amount for the year ahead. For this reason, it’s crucial that medical coders fully understand the HCC coding guidelines and get them right.

For more information regarding the Medicare Advantage program or the HCC model, review our previous article, “HCC Medicare Advantage Background and Overview.”

Furthermore, if your coding team needs HCC coding help, here are 4 HCC coding best practices. You can implement these right now to see a positive impact immediately.

4 HCC Coding Best Practices

Planning and Experience

Add an HCC Coding Specialist to your team. The first step to making practical improvements is to hire a specialist. A specialist will ensure each patient’s RAF score is correct to result in better clinical care and experience. In addition, the specialist will help bolster physicians’ incomes by bringing in more savings and assigning a proper risk score benchmark.

Educate with a continued HCC coding training plan. Additionally, ongoing education on HCC coding guidelines is essential for every healthcare provider. YES HIM Consulting’s robust educational program specializes in HCC coding training and risk adjustment models. Furthermore, the flexible education formats allow coders to take the training on their own time, and include one-on-one coaching and live Q&A sessions. Our latest article, “Medical Coding Training on Updates Ensures Accuracy & Compliance Standards,” dives into the additional benefits of ongoing education.

Utilize Your Data Effectively

Utilize real-time reporting features of value-based programs to submit reports quicker. Cut down on the reporting time between the patient visit and coding of the encounter to deliver actionable insights on how well the provider is performing. Continually updating the provider’s performance data will also help improve operations and take advantage of outstanding reimbursements.

Create a full-picture view of each patient by including specificity of HCC chronic conditions. Create complete, accurate patient records that include medical histories, procedures, treatments, and chronic conditions. In addition, specificity in HCC documentation and coding creates a domino effect; accurate, complete documentation of chronic conditions affects the mode of treatment and corresponding HCC codes. This, in turn, leads to the payment amount. Using specificity in documentation also impacts the face-to-face visit with the physician. Therefore, it is imperative to share that data prior to the encounter, so providers can deliver better care. For examples of how specificity in documentation and coding affects RAFs and payments, review our article, “The Importance of Specificity in Documentation and Coding HCCs.”

Use the M.E.A.T. Criteria Model for accurate coding. The M.E.A.T. Criteria (monitoring, evaluation, assessment, treatment) verifies that the risk adjustment data that was sent for reimbursement is wholly precise and credible.

Additional Information

Furthermore, for in-depth information about the HCC risk adjustment process, review our latest article, “Everything You Need to Know About the HCC Risk Adjustment Models.

Lastly, YES HIM Consulting’s team of qualified coding and auditing specialists is ready to provide you with actionable strategies and help. If you’re interested in our HCC services, HCC training, or other valuable programs, contact YES today!

Mari Cely

Director, Business Strategy & Marketing
hcc coding

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