BC Advantage - 2016 Issue 1

HCC Coding

What is HCC coding? Hierarchical Condition Category (HCC) is a risk adjustment model implemented by CMS in 2004 to estimate predicted costs for Medicare beneficiaries based on disease and demographic risk factors, leading to increased payments for high-risk patients. Inaccurate reporting of HCC chronic conditions and their associated HCC codes may lead to significant loss of revenue opportunities.According to Dr. Todd Husty, "Currently 90-95 percent of all risk-adjusted ICD-9 and ICD-10 codes are assigned by physicians... that doesn’t make sense. Physicians are not coders and probably never will be."  It makes sense to hire certified professional...

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