Hierarchical condition category (HCC) coding is a risk-adjustment model
originally designed to estimate future health care costs for patients
.
What does HCC mean in coding?
An
Introduction to Hierarchical Condition Categories
(HCC)
What does a risk adjustment coder do?
What Does a Remote Risk Adjustment Coder Do? As a remote risk adjustment coder, your duties and responsibilities involve
performing medical coding and reviewing medical codes for adherence to risk adjustment models
. Employers may also expect you to audit medical record data to ensure accuracy.
What does HCC mean in medical 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.
How does HCC risk adjustment work?
During the risk adjustment process, HCCs are each assigned a Risk Adjustment Factor (RAF). CMS uses RAFs
to predict ongoing care costs for the following year and adjust capitated payments to the health plan
.
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.
- Tracking performance and identifying opportunities.
What is an HCC risk score?
The risk scores
measure an individual recipient’s’ relative risk
, and risk scores are used to adjust payments for each recipient’s expected expenditures. Several factors impact the risk score, but generally, the HCC risk adjustment is based on the enrollee health status and their demographic characteristics.
Is medical coding a dying career?
The short answer for those in the medical coding and medical billing fields is
“no
.” The fact is, a coder continues to be in high-demand – especially those who have completed a Medical Coding Certification program. That’s because nearly every healthcare provider uses coded documentation and records.
Which Coding Certification is best?
- Certified Professional Coder (CPC) credential from the AAPC. …
- Certified Coding Specialist (CCS) credential from the AHIMA. …
- Certified Coding Specialist – Physician-based (CCS-P).
How much do risk adjustment coders make?
While ZipRecruiter is seeing annual salaries as high as $60,000 and as low as $27,000, the majority of Risk Adjustment Coder salaries currently range between
$41,500 (25th percentile) to $54,000 (75th percentile)
with top earners (90th percentile) making $56,500 annually across the United States.
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 often are HCC codes updated?
Just as ICD-10-CM diagnosis codes are updated
yearly
, so are diagnoses within HCCs. As an example, in 2018 CMS added substance abuse disorder, mental health and chronic kidney disease diagnoses to HCCs.
What are the risk adjustment models?
Risk adjustment models were created in the 90’s by academia and funded by CMS as a method to adjust capitated payments to Medicare and Medicaid HMOs. The models are
designed to predict future expenditures of enrollees based on diagnosis codes reported on claims and encounters
.
How is HCC risk score calculated?
Sum of factors
Demographic + Disease = Raw risk scores
The relative factors for all of the demographic variables, HCCs, and interactions are added together. The result is the raw risk score.
How does risk adjustment work?
As defined by the Centers for Medicare and Medicaid Services (CMS), risk adjustment
predicts the future health care expenditures of individuals based on diagnoses and demographics
. Risk adjustment modifies payments to all insurers based on an expectation of what the patient’s care will cost.
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.
