An Introduction to Hierarchical Condition Categories (HCC)
What is an HCC diagnosis?
HCCs, or Hierarchical Condition Categories, are sets of medical codes that are linked to specific clinical diagnoses . Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions.
What does the HCC mean after a diagnosis?
Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. ... CMS requires documentation in the person’s medical record by a qualified health care provider to support the submitted diagnosis.
What does HCC risk code mean?
Hierarchical Condition Category coding , or HCC Coding, was first implemented by the Centers for Medicare and Medicaid Services (CMS) in 2004, as a way for medical groups to estimate a patient’s future health care costs in value-based payment models.
What is HCC value?
Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. ... Along with demographic factors (such as age and gender), insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score.
What is a good HCC score?
Risk scores generally range between 0.9 and 1.7, and beneficiaries with risk scores less than 1.0 are considered relatively healthy.
What is the HCC process?
The HCC process includes a prospective review of health status in a base year to predict costs in the following year . Assessments are also made of beneficiaries eligible for both Medicare and Medicaid (dual eligibility).
How many HCC models are there?
There are two different models for Hierarchical Condition Category (HCC) risk adjustments. The U.S. Department of Health and Human Services (HHS) oversees the HHS-HCC risk adjustment model 2020, which covers commercial payers of all ages and determines risk payments for the current year.
Is HCC coding hard?
If experienced medical office workers struggle with HCC coding, how hard will it be for someone with no experience? The difference is in the training . Although few can simply sit down and begin HCC coding, the training is very straightforward.
What is HCC mood disorder?
Severe: True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a long period of time.
What is the meaning of HCC?
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.
How can I improve my HCC coding?
- Having an accurate problem list. ...
- Ensuring patients are seen in each calendar year. ...
- Improving decision support and EMR optimization. ...
- Widespread education and communication.
What do HCC coders do?
An HCC coder, or hierarchical condition category coder, is someone who transcribes a patient’s medical history into a database using standardized codes . This includes diagnosis and treatment and is typically later used for insurance and medical billing purposes.
What is major depressive disorder HCC?
According to the American Psychiatric Association, Major Depressive Disorder can be seen in patients who have suffered a depressive episode lasting at least two weeks, as manifested by at least five (5) of the following symptoms: depressed mood, loss of interest or pleasure in most or all activities, insomnia or ...
How much do HCC coders make?
The highest salary for a HCC Medical Coder in India is ₹35,594 per month . The lowest salary for a HCC Medical Coder in India is ₹15,000 per month.
What are HCC gaps?
HAP has a Hierarchical Condition Category, or HCC, gap closure program. An HCC is a group of diagnoses used by CMS in their risk adjusted reimbursement model for Medicare Advantage plans. These codes are the primary indicators of a member’s health status. Most HCCs are conditions that tend to be chronic in nature.
