Hierarchical Condition Categories (HCC) is a coding system developed by Medicare to pay Medicare Advantage insurance companies, based on demographics and the disease burden of the beneficiaries. Though HCCs can seem intimidating, they don’t have to be a risky business.
Medical practices depend on coding for more than payment. Diagnosis coding communicates the disease burden of an individual patient, as well as a panel of patients within a practice. In the transition from volume-to-value, diagnosis coding changes the process of reimbursement and predicts the costs of caring for patients. In this new world, medical practices must understand how risk adjusted diagnosis coding works.
With that in mind, we’ve compiled the educational resources on this page to guide medical coders and practitioners in following ICD-10 rules and accurately reporting diagnosis codes on claim forms.
In this blog post, Betsy gives an overview of Hierarchical Condition Categories (HCC), a coding system developed by Medicare to pay Medicare Advantage insurance companies based on demographics and the disease burden of the beneficiaries.
In this 60 minute webinar, Betsy and Dr. Edwin Knights discuss how to accurately and compliantly report diagnosis coding in practices with risk-adjusted contracts. Dr. Knights is the physician champion for his practice, and has invaluable insights into how to implement a strong program in a busy primary care practice.
CMS reviews and updates their HCC model annually. Some years, there are no coding changes to the HCC model. In 2018, CMS made a few changes to the model used to pay Medicare Advantage plans. Read about those changes in HCC coding in this blog post.
There are two models of HCC diagnosis coding. Both were developed by Medicare, and each serving a different purpose. This blog post explains the difference between these two HCC coding models.
How do we get paid for physician services in medical practices? Watch this 10-minute video and download the handouts for an overview of HCC diagnosis coding, the first of three modules.
Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24-page guide is an introduction to risk adjustment coding and the risk adjustment factor (RAF).
Medical groups that are part of Accountable Care Organizations (ACOs), or that have commercial risk based contracts need to assign diagnosis codes carefully. This blog post about a recent conversation with a fellow coder illustrates the importance of this perfectly.
This article describes risk coding for common, chronic illnesses. It isn’t comprehensive for all chronic conditions, but focuses on commonly seen conditions in medical practices. For information about specific conditions including depression, diabetes, compliance and more, see related links on this page.
Everyone loves to read the general guidelines at the front of the ICD-10 book, right? No? Most of the articles I’ve written have focused on the first sentence in this guideline. This article will focus on the second, “Do not code conditions which no longer exist.”
60 minute webinar || In fee-for-service medicine, physician services are paid based on the fee associated with that CPT® code, HCPCS code and modifiers. The diagnosis coding establishes the medical necessity for this service. With new payment models, diagnosis coding for physician services takes on added importance and affects future payments.
In this video we’ll be talking about compliance issues related to risk-based diagnosis coding. We’ve included two handouts to go along with the video, both including additional detail. Be sure to download them before you begin watching!
This article explains why medical practices need to accurately code for diabetes, in particular, when the patient has a manifestion or complication, and why you should avoid using the uncomplicated code if the documentation describes a diabetic complication. Specific examples are included.
This article reviews key issues relevant to diagnosis coding for depression and risk adjustment factors in the HCC coding system.