HCC coding can be a tedious and intimidating process, with thousands of codes to choose from that all link back to different categories – and no cheat sheet to guide you through the process. But given the importance of HCC coding for both Medicare reimbursements and patient care, it is vital to make coding as easy as possible for your providers.
That’s why we created this article: to offer a clear, easy-to-reference resource that will ensure you produce accurate coding – and receive the full funding you are entitled to.
There are two types of codes that help you attain your risk adjustment factor (RAF) score: the hierarchical condition categories (HCC) codes and the international classification of diseases (ICD) codes.
Risk adjustments allow CMS to make appropriate and accurate payments for enrollees with differences in expected costs. Risk adjustment adjusts bidding and payments based on demographics–such as age, gender, and race–and the health status of an enrollee.
The RAF scoring model aims to predict the future healthcare costs for specific enrollees for CMS health plans based on their current risk factors associated with their population. Using HCC diagnostic groups, providers and insurers can assess the disease information of enrollees.
For context, There are more than 72,000 ICD-10 codes, and 9,757 ICD-10 codes that map to one of the eighty-six HCC codes within the Centers for Medicare and Medicaid Services (CMS)-HCC Risk Adjustment Model. When you take a look at these numbers, it’s no wonder why more providers and coders are looking for HCC coding assistancewhen calculating RAF scores.
Having the right coding tool can streamline your coding practices and optimize your patient care. Inferscience offers an array of coding tools, such as the HCC Assistant, which provides you with HCC risk adjustment code suggestions after analyzing your patient’s EHR and health record.
With HCC coding tools, you can access the codes you need in real-time. This tool gives you the shortcuts you need to focus on your practice, instead of combing through thousands of codes for the right ones. In this article, we’ll dive into the purpose of risk adjustment coding, critical principles for coding, and shortcuts to the most-missed HCC opportunity codes.
Selecting the correct codes is only one critical step in managing high-risk patients. These tips will help ensure you are getting credit that is accurate to the care and management you provide for your high-risk patients:
While billing and reimbursement are important reasons to be diligent about your HCC and ICD codes, these codes also serve as critical documentation that can directly impact your patient’s quality of care.
Even with diagnoses with higher prevalence in your practice or specialty, ICD-10 diagnosis codes are often missed, which can result in inaccurate RAF scoring. Here are some of the most commonly missed ICD-10 diagnosis codes that are connected to HCC opportunities according to Delaware Valley Accountable Care Organization:
There are also HCC codes that are missed due to their lower prevalence in the population, but come with a significant average risk score. For example, pressure ulcers of skin with necrosis through muscles or tendons have an average risk score of 2.253.
When these codes are missed, not only does it make things more complicated for your coders and insurance, but your patient suffers, as well. When diagnoses are missed, your patients run the risk of receiving incomplete care.
Inferscience’s software solutions simplify your HCC coding practices. The HCC Assistant allows you to analyze patient data from the electronic health record (EHR) or external sources, and provides HCC coding suggestions in an intuitive, expandable tab.
With the HCC Assistant, you will be able to streamline your HCC coding practices for your Medicare patients and provide optimal care. Not only does our innovative natural-language processing (NLP) tool streamline the process and save providers hours of manual effort – it increases the average provider’s RAF scores by 35%.
Want to see how it could improve your risk-adjustment workflow?
References:
https://www.mainlinehealth.org/-/media/files/pdf/basic-content/physicians/mlhpp/resources/dvaco-prms-commonly-missed-and-confusing-hcc-codes.pdf
https://www.hccinstitute.org/app/uploads/2021/09/HCC-Quick-Reference-Guide_210608.pdf?x23823
https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/hierarchical-condition-category.html
