Proper hierarchical condition category (HCC) coding is crucial to paint the full picture of a patient’s health, particularly concerning the long-term complexity of treatments they’ll need for certain diagnoses.
But many providers struggle with gaps in their HCC coding – leading to unoptimized risk adjustment factor (RAF) scores, less effective patient care, and missed Medicare Advantage funding.
This article explores the most common methods to avoid errors in your HCC coding – and reveals one solution that can close these gaps and increase your RAF scores by an average of 35%.
When healthcare providers create complete, precise records with a full log of all procedures, conditions, complications, comorbidities, diagnoses, and interventions, there is less potential for an HCC code to be missed or misreported.
Best practices here include:
There used to be 19 different categories of HCC codes and 86 HCC codes. But changes enacted in 2024 mean there are now 115 different payment HCCs – which puts pressure on providers to ensure maximum precision in their coding.
Every provider should ensure their physicians are aware of these changes and take measures to be extra specific when documenting diagnoses – to ensure they assign the right values and accurately determine risks.
Chronic conditions must be documented every year to be factored into risk adjustment calculations. But many providers fail to revalidate data – which can lead to inaccurate HCC coding.
Follow-ups must be made to keep track of any patient’s health conditions and those who don’t get to visit their physicians annually should be flagged so that annual wellness check-ups can be scheduled.
Well-trained HCC coders can identify and intercept issues and omissions before they have an impact, ensuring that the calculated risk score documented by Medicare or a relevant payer is accurate and aligns with anticipated patient care expenditures. But many providers lack the time or resources to offer their staff adequate education.
Overcoming these constraints to offer coding training can dramatically reduce human error. This could be supplemented if necessary by hiring extra staff – such professional HCC coders or care coordinators.
While every solution discussed above can help reduce HCC coding gaps, many are either difficult to instantiate or unreliable. Human error is a major cause of HCC coding errors and simply encouraging your staff to be more specific or improve their documentation process is unlikely to be a sustainable solution to the problem of HCC coding gaps.
Instead, there is really only one way to ensure your gaps are closed – and that is by solving the problem with technology.
Inferscience’s HCC Assistant is an EHR-integrated HCC coding platform that increases the average provider’s RAF score by 35%. It uses natural-language processing (NLP) to analyze structured and unstructured data in a patient’s medical chart and leverage complex rules to find diagnoses that may have been overlooked – before displaying them as recommended HCC codes in real-time.
For physicians, this makes life simple and gives them more time to focus on patient care.
You simply:
As a result, you can:
All with a single easy-to-implement solution.
Want to see it in action?
