3 Important Facts About HCC Coding

HCC Coding Definition

HCC coding is a type of specialty coding and it’s hierarchical coding and that’s done for Medicare Advantage. Since 2004, Medicare has used the HCC Coding (Hierarchical Condition Categories) model to calculate payments to providers and health plans, but the sad truth is that most MA plans and their aligned physicians continue to miss significant opportunities to serve their members and maximize their revenue potential because of poor performance in this area.

The good news is that it need not be that way. Here’s an excerpt of an article written by Pam Klugman in Physicians Practice on how HCC coding was designed to provide greater efficiencies and enhanced quality and revenues for physicians serving the MA market:

1. Know how many diagnosis codes your claims system is capable of storing. Data is often lost merely because your system does not have a place to hold it. To ensure you are receiving accurate reimbursement, you must be able to capture and send all diagnosis codes from your claims and encounters.

2. While utilizing the ANSI-837 claims format may make you HIPAA compliant, the process may not be capturing all relevant clinical information. In some cases, providers and EDI vendors have mapped their legacy transaction set to the new format. This results in capturing the original nine codes — one primary (plus eight secondary) diagnoses — and continues to omit diagnosis 10 and beyond. Don’t let this happen to you.

3. Often payable claims take priority over encounters due to the federal regulations on timely payment of claims. If you are close to a CMS sweep, make sure there is no backlog of encounter data unprocessed, which could have detrimental effects on your revenue.

4. Your appeals department receives full medical records. Have a coder review them to see if there are any additional diagnostic codes to be found that will have a positive impact on your HCC scores.

Read full article: http://www.physicianspractice.com/blog/hcc-coding-10-tips-top-scores

HCC Coding Risk Adjustment Training — VIDEO

HCC Coding Training

Providers and insurance companies are actually looking for specialty certified coders. With specialization in HCC coding comes a higher salary. Normal medical coders can expect to earn $32,000 per year. HCC Coders, however, can expect to earn a higher salary of $53,000 per year according to SimplyHired.com.

Certification Coaching Organization (CCO) provides full online HCC coding training, basic and experienced. They are also offering it to medical coders who enjoy diagnosis coding and wants to deal with Medicare Advantage plans. Or to those who has an existing understanding of ICD-9-CM and or ICD-10-CM but want to learn more and improve their understanding of Risk Adjustment methodologies and are looking to enter and exciting new trend in medical coding.

HCC Coding Guidelines

Physicians who do not exercise good documentation at each patient encounter with the chronically ill will receive fewer resources from health plans and will have less ability to grow.

Good documentation begins at the time of the patient’s face-to-face encounter with the physician. It means the physician documents the clinical findings in the medical record, and the medical record is used to determine ICD-9-CM codes. The pertinent information from the patient encounter is submitted to the MA organization for payment.

Guiding Principle:

• The risk adjustment diagnosis must be based on clinical medical record documentation from a face-to-face encounter,

• coded according to the ICD-9-CM Guidelines for Coding and Reporting; assigned based on dates of service within the data collection period,

• submitted to the MA organization from an appropriate risk adjustment provider type and an appropriate risk adjustment physician data source.

In addition to the Guiding Principle, risk adjustment data validation guidelines include the following:

• The medical record documentation must support an assigned HCC.
• Beneficiary HCCs and risk adjustment records are selected based on risk adjustment diagnoses (ICD-9 codes),
• Provider type,
• Health Insurance Claim (HIC) number that is submitted to the Risk Adjustment Processing System (RAPS).

Source: http://health-information.advanceweb.com/Article/The-ABCs-of-HCCs-Decoding-CMSs-Hierarchical-Condition-Categories.aspx

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