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What is HCC coding?

What is HCC Coding? HCC stands for hierarchical condition category coding. This is a risk-adjustment model that was originally designed to estimate future healthcare costs for patients.

What is the hierarchical condition categories (HCC)?

The Hierarchical Condition Categories (HCC) is a risk-adjustment model that has existed for many years. With the introduction of the Medicare Advantage Plans and its requirement of RAF reimbursement scores, the HCC has become more popular.

What is an HCC score and why does it matter?

HCC scores have been used since 2004 by Medicare to adjust payments based on the risk level of the enrollee. This has resulted in Medicare paying a higher monthly capitation fee for patients with higher HCC scores as these require more resources and disease intervention. So, what is HCC in medical terms and what is HCC healthcare?

How do insurance companies use HCC coding to predict costs?

Along with demographic factors (such as age and gender), insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurances can use a patient’s RAF score to predict costs. For example, a patient with few serious health conditions could be expected to have average medical costs for a given time.

What is HCC in healthcare?

HCC stands for hierarchical condition category coding. This is a risk-adjustment model that was originally designed to estimate future healthcare costs for patients. The model was created in 2004 by the Centers for Medicare & Medicaid Services (CMS) but is becoming even more prevalent as the healthcare industry shifts to value based payment models.

Why is HCC Coding important?

HCC coding is essential for health plans because it helps get an idea of the patient as a whole and their associated costs. HCC coding also helps predict health care resource utilization while adjusting quality and cost metrics.

What is the purpose of the Hierarchical Condition Category?

Hierarchical condition category uses ICD-10 coding to assign risk scores to individuals. Along with other demographic factors like gender and age, insurance companies use this coding scale to assign risk adjustment factor (RAF) scores to patients. Algorithms then predict healthcare costs for an individual based on their RAF score.

What are the main categories of HCC?

The main HCC categories are bipolar disorders, pulmonary disease, diabetes, congestive heart failure, rheumatoid arthritis, prostate & breast cancer and specified heart arrhythmias.

What does HCC mean in medical coding?

So, what does HCC stand for in medical coding? The Hierarchical Condition Categories (HCC) is a risk-adjustment model that has existed for many years. With the introduction of the Medicare Advantage Plans and its requirement of RAF reimbursement scores, the HCC has become more popular.

Can a physician document HCC?

While physician and other healthcare providers can document the services performed accurately, legibly and completely, collaborating with the right medical coding company with experience in HCC coding will ensure accurate code assignment.

Is HCC a good equalizer?

Therefore, the HCC is a great equalizer. Before the rise of the risk adjustment model, reimbursement was solely based on demographic factors. Costs may vary widely among patients. As such, risk adjustment can be used to evaluate patients on an equal scale.

What is the HCC in Medicare?

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 or simply, the category of medical conditions that map to a corresponding group of ICD-9 diagnosis codes. The number of HCCs and affected ICD-9 codes can change from year to year and with the implementation of ICD-10, it will significantly impact the number of HCCs and the number of diagnosis codes currently in effect. There are approximately 87 risk score categories which map to over 3,000 different ICD-9 codes. In order to accurately reflect a patient’s risk profile, it requires more than the standard ICD-9-CM codes commonly seen in current billing practices. Source: http://www.advantageplan.com/wp-content/uploads/ADV-HCC-Presentation_Final_111114AB.pdf

What is CCO in coding?

Certification Coaching Organization (CCO) is offering an online HCC Coding Training Course /Risk Adjustment Training currently . With limited education available for coders seeking risk adjustment coding skills, this course so valuable. Whether you are an experienced coder in risk adjustment or seeking better understanding, this course will take you through the fundamental principles underlying risk adjustment coding and prepare you for the CRC exam.