Hierarchical Condition Category Coding (HCC) measures the complexity of a patient’s long-term health status and care. It is challenging to paint a complete picture of a patient’s health without expertise and analysis. Care professionals must review the entire patient record and consider the social determinants of health. Using HCC, they can calculate risk-adjusted quality and cost metrics. The codes also track patient demographics, which help determine cost performance. You can also learn more in hierarchical condition category coding – Foreseemed.com.
Co-existing conditions provide a holistic view of the patient.
In the past, holistic approaches to patient care have been overlooked. While pharmaceutical companies invest heavily in patient engagement strategies, they often tend to the holistic aspects of patient care. Too often, “patient” is used as a generic, nebulous term. A holistic approach to patient care, on the other hand, considers the patient as an individual with unique characteristics and needs. The patient’s unique profile affects the patient’s experience of the treatment and care.
ICD-10-CM codes are used to assign risk scores
The ICD-10-CM code set includes a variety of categories for medical conditions and their risk factors. These categories provide better information about health conditions and disease risks. The codes reflect socioeconomic and psychosocial factors influencing a patient’s risk of disease and health problems. This code set includes codes for Z55 to Z65, which are associated with conditions related to socioeconomic and psychosocial circumstances.
There are ninety-nine ICD-10-CM codes that map to 79 different risk categories. Physicians providing care must document diagnoses for each type. Then, for each HCC category, a Risk Adjustment Factor (RAF) is assigned, which scales payments to reflect the patient’s risk factor. HCC codes are also used to risk-adjust Medicare Advantage payments and for care provided through some demonstration projects. In these cases, the CMS pays a capitated amount to the plan.
Coders must be precise in their documentation.
HCC coding is a risk-adjustment coding model that attempts to communicate the complexity of patient care. HCC scores are used to assess and predict health care resource use by taking a long-term view. This data is used to develop risk-adjusted quality and cost metrics for all healthcare providers. The HCC model is beneficial for measuring the quality and cost performance of care in the context of a patient’s social determinants of health.
Physician documentation is critical when using HCCs. Documentation must be complete and specific and based on a face-to-face encounter. It must include the diagnosis and treatment plan for a given patient. Incomplete documentation may result in an inaccurate diagnosis or a false positive. Educate your providers about the importance of correct documentation. Incomplete documentation may lead to errors in coding and should be addressed by your organization.
HCC coding helps communicate patient complexity
In the value-based care environment, accurate documentation of patient complexity is essential for reimbursement. The patient’s annual complexity account directly affects healthcare organizations’ cost/utilization ratios. To properly communicate the complexity of a patient cohort, healthcare providers must understand the nuances of HCC coding. With the rise of risk adjustment and value-based care, healthcare organizations must understand the impact of HCC coding on patient costs and reimbursement.
The challenges of the healthcare environment make it vital for healthcare providers to do everything possible to stay afloat and competitive. Unfortunately, many physicians and healthcare organizations are overwhelmed by the sheer number of demands. With HCC coding, however, these doctors can increase revenue, minimize disruption to patient care, and receive a dramatic ROI. But capturing HCCs in an EHR is not always easy.