HCC Coding: Reduce Compliance Risks Through Audits

A formula for improved financial outcomes? Or a recipe for fines and penalties? In fact, the use of certain ICD-10-CM diagnosis codes mapping to hierarchical condition categories (HCCs) can be both. On one hand, these diagnosis HCC codes provide revenue enhancement by risk-adjusting payments to account for sicker Medicare and Medicare Advantage beneficiaries. But using the wrong ICD-10-CM codes and/or relying on weak clinical documentation can increase your compliance risks and may result in adverse auditor determinations. In recent months, the Office of the Inspector General (OIG) has published several reports detailing noncompliant HCC coding and documentation leading to overpayments.

As Gloryanne Bryant explains in this ICD10monitor webcast, reducing your compliance risks starts with an effective HCC auditing program, performed by an internal team and/or by an outside consulting firm. Through ongoing audits, you can uncover coding risks, gaps and vulnerabilities in your current documentation and coding practices and then take prompt corrective action — before you come under external auditor or regulatory scrutiny.

Why This is Relevant:

Much is riding on the accuracy of your HCC diagnosis coding and the strength of the supporting documentation, both in terms of bottom line impact for your organization and the capture of data that enables CMS to estimate future spending. Consequently, the OIG and other auditors are shining an increasingly bright light on payments involving HCC risk-adjusted patients. Noncompliance can prove to be very costly, not just financially, but also operationally and in the damage to your organization's reputation.

Learning Objectives:

• Understand your compliance risks and how HCC auditing can lead to improvements
• Reinforce your knowledge of Medicare Advantage risk-adjustment HCC requirements and many high-risk ICD-10-CM diagnosis codes
• Comprehend OIG reports and the recommendations for Medicare Advantage risk-adjustment HCCs
• Identify risks, gaps and vulnerabilities in your clinical documentation and ICD-10-CM coding
• Learn how to improve coding accuracy, data integrity and compliance with HCC auditing practices

Who Should Attend:

This webcast will be most relevant to HIM coding directors/managers, hospital inpatient and outpatient coders, revenue cycle directors/managers, compliance directors/managers, HCC coding consultants and auditors, and educators.

Webcast Access Privileges: Only one login is allowed per webcast purchased. Discounted pricing for additional registrants is available. For more information about webcast pricing and requirements, click here.