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HCC Coding Services

Hierarchical Condition Category (HCC) is a new term introduced by the Medicare and Medicaid for paying bills of patients particularly based on the demographic information and patient’s health status. For determining how much costly the patient is a risk adjustment factor is determined. The risk adjustment factor depends upon diagnosis information collected from claims, medical records which are collected by physician offices, inpatient visits and outpatient consultations.

The patients who are healthy are given a below average risk adjustment factor score. The patients premium is transferred from patients having below average risk adjustment factor score to above average risk adjustment factor score. Under this payment model the patients who are having similar practice will have different payment rate because of the risk adjustment factor score.

1. How does HCC works?

Now let’s discuss about top HCC categories.

These are the top 5 HCC categories:

  1. Major depressive and bipolar disorders.
  2. Asthma and pulmonary disease.
  3. Diabetes
  4. Specified heart arrhythmias
  5. Congestive Heart Failure

Now we shall see how the patients are assigned to diseases.

            Based on the risk adjustment factor, demographic information a patient can be given more than one kind of disease or illness. The risk adjustment model performs in depth analysis and allocates a sum of money to the patient based on the illness and its forecast for next year. This is the way HCC works.

2. The Key is Specificity

  1. CMS-HCC is hinge-on serious or chronic health conditions.
  2. The physicians must assiduously report on each patients risk adjustment and they should be based upon the medical documentation from a face-to-face encounter with the patient.
    Based on the above two statements we can conclude that physicians cannot determine the patients Risk Adjustment Factor (RAF) depending upon the test results or patient’s medical history. The each and every test is used to determine the patients RAF score and the score is calculated on the following basis.

    1. The score is not only for re-imbursement to the payer but also to
      • The amount of money that is required to the patients cure from the disease for the upcoming years of his life, which could be next one year or so.

3. Meat

      The physicians can achieve the required documentation standard by understanding what is MEAT?

Let’s discuss about MEAT and its base.

MEAT is an acronym used in HCC to make sure that the most precise and complete information is being documented.

MEAT is abbreviated as
Monitor-signs and symptoms, disease process
Evaluate-test results, meds, patient response to treatment.
Assess/Address-ordering tests, patient education, review records, counseling patient and family members.
Treat-meds, therapies, procedures, modality

4. Coder’s duty in HCC coding

  1. The medical coder has to give utmost care and attention to the patient medical record and all factors such as supporting documentation about the status of each condition must be fully represented.
  2. The diagnosis and its results should not be only inferred to test results but also to each condition documented on the record. The documentation must show that the condition is monitored and documented.
  3. Each diagnosis should have an assessment and a plan. The treatment and level of care must be justified and the patient health status must be considered. All chronic conditions must be monitored and reported at least once a year.
  4. The main aim of HCC is to allow the patient to become healthier and also precise payments to Medicare advantage plans.
  5. For achieving this goal the medical coder should follow the following
    1. He should be an updated medical coder having good practice and educated on HCC.
    2. He should have knowledge in medical field, and also to diagnosis, treatment given to the patients.
    3. The RAF should be prepared by the medical coder so it should perfect in all points such as
      1. Accurate diagnosis codes and
      2. Complete clinical documentation.
  6. Proper report preparation using HCC codes will lead to accurate patient score and it will prevent audit of claims. Once done perfectly it will lead us to
    1. Proper streamlining of claims and
    2. Fast re-imbursements.

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Why Choose us?

  • Our knowledge towards understanding the concept of medical coding is unrivalled in the industry and our continuous actions to improve our coding information and compliance initiative through education and training academy, industry updates and work experience makes us to compete with best in industry.
  • We afford precise and quality medical coding services to all healthcare providers.
  • We afford prospective and retrospective coding services for Medicare , Medicaid and commercials using specific modes like CMS-HCC, HHS-HCC
  • We are hallowed to have a extensive group of experience medical coders, who are certified by AAPC with certifications like, CPC, CRC, COC and CIC.
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