Hierarchical Condition Category (HCC) codes are essential in transitioning the healthcare system from fee-for-service to value-based care reimbursement models. HCC codes are used for risk adjustment, forecasting medical costs for patients with complex healthcare needs, and determining reimbursement rates for Medicare Advantage, Accountable Care Organizations, and some Affordable Care Act plans.
The nature of HCC coding is complex, with thousands of diagnosis codes mapping to different HCC categories. The stakes involved are high, and accuracy is critical to ensure appropriate reimbursements. Proper documentation of HCC codes significantly affects reimbursement rates, positively or negatively.
Download our white paper, “Optimizing HCC Coding for Accurate Reimbursement in Healthcare,” to gain a better understanding of:
- Strategies for accurate and compliant HCC coding and maximizing reimbursement rates
- Challenges faced in accurate HCC coding, including incomplete medical records, limited resources, and rapidly evolving regulations
- How to optimize HCC coding and reimbursement, including adhering to MEAT criteria (monitor, evaluate, assess/address, and treat), focusing on high-value encounters, collaborating with health plans, and engaging physicians in the query process to improve documentation
- How implementing technology tools like computer-assisted coding can facilitate needed improvements in HCC coding and documentation
