Every value-based care (VBC) provider wants to improve their patient outcomes and deliver best-in-class service. But what are the factors that will truly impact the quality and consistency of care?
One key element is your capacity to equip providers with a reliable view of their patients’ long-term needs – and that is why accurate HCC coding is foundational to better patient care.
Hierarchical condition category (HCC) codes are used to group related diagnoses. For example, herpes simplex myelitis and varicella myelitis would be categorized with the same code. These groupings form the core of the HCC risk adjustment model: a method used to estimate the future cost of care for Medicare Advantage patients – and ultimately calculate reimbursements for the provider.
It does this using risk adjustment factor (RAF) scores. The Centers for Medicare and Medicaid Services (CMS) leverages historical data about the costs associated with each HCC code – as well as various demographic factors such as age and gender – to attach RAF scores to each code. Providers can then combine each patient’s HCC codes and demographic data to produce an official RAF score, which dictates how much they can claim from Medicare Advantage to support the patient’s care.
HCC coding is therefore the process of reviewing medical records and identifying supported diagnosis codes. It can be done by providers or professional coders, though a growing number of value-based care providers are leveraging natural language processing (NLP) solutions to automate large parts of the process and produce faster, more accurate coding recommendations.
HCC coding influences the quality and reliability of care in three vital ways:
HCC coding requires accurate, up-to-date documentation of every patient’s medical history. Without this, diagnoses may be missed that could significantly reduce the Medicare reimbursements a provider receives.
The upshot of more accurate documentation is greater insight into a patient’s care needs. Providers can more easily view the patient’s full medical history and make connections to understand their current condition.
Accurate HCC coding can also form the foundation of a patient’s care plan. Providers will use the patient’s codes to identify the most efficient treatment paths and understand how interventions are likely to impact the patient’s future health and care costs.
Quality patient care requires tools and resources – and that often comes down to funding. HCC coding is therefore essential to enable value-based care (VBC) providers to receive the payments they need to meet a patient’s changing care needs in a timely manner.
HCC coding is always a net positive for patient care, but that does not mean it cannot create challenges for providers. Providers often struggle with missing diagnoses and codes which:
As a result, it’s essential that providers find ways to facilitate more accurate and efficient risk adjustment using technology – so that providers can focus on patient care with a reliable view of the patient’s needs.
While HCC coding is essential, the process can be extremely time-consuming – and many providers feel it takes their attention away from patient care.
That is why we created HCC Assistant: a solution designed to enhance and accelerate HCC coding while freeing providers to focus on caring for their patients. Using natural language processing (NLP) to ingest and analyze a wide range of structured and unstructured patient data, the tool makes HCC coding recommendations at the point of care, with 97% accuracy.
This helps value-based care providers:
Want to see how it could help deliver better care for your patients?
