Hierarchical Condition Categories (HCC) were mandated in 1997 by the Centers for Medicare and Medicaid Services (CMS) and have been the basis for reimbursement for Medicare Advantage plans (MA) since 2004 and enrollment into this model continues to grow. But Risk Adjustment (RA) and HCCs – long thought to be only the domain of physician practices - can be confusing for health information management (HIM) coding and clinical documentation integrity (CDI) professionals. For example, how do more than 9,700 ICD-10-CM codes map to one or more of the 86 HCCs within version 24 of the CMS HCC RA model? Knowing how those codes map to HCCs is vital in your understanding of what documentation specificity is needed to capture the correct ICD-10-CM codes since reimbursement is tied to the correct HCCs.
The ICD-10-CM codes that map to HCCs are what drive risk adjustment factor (RAF) scores and the per member per month (PMPM) premiums that are paid to an MA plan. ICD-10-CM codes that equate to HCCs are an essential part of the HIM coding and CDI professionals' foundational knowledge. Coding accuracy and documentation integrity can be helped by understanding the linkage between HCCs and ICD-10-CM codes to assign as you'll learn in this timely and important webcast – part II of this two-part series - "Learning Made Easy for Risk Adjustment and HCCs Part II: Getting the Coding Right."
Click here for information about the two-part series.
Why This is Relevant:
Non-specific clinical documentation can lead to coding errors with HCCs, thus impacting the entitled revenue. Increases in federal scrutiny and potential RADV audits mean HIM coding and CDI professionals need to ensure accurate and complete coding and documentation.
Take this brief quiz to see if you and your team could benefit from this webcast:
- How do I ensure the documentation is complete and accurate for the HCC data we submitted?
- What HCCs are there for a diagnosis of pneumonia?
- What are some solutions and strategies for accurate data capture?
- How can we be proactive rather than reactive to CMS RADA audits?
- Understand Risk Adjustment HCCs and the link to ICD-10-CM coding
- Gain greater knowledge of the documentation issues and lack of specificity that can occur
- Enhance diagnostic coding skills through review of case scenarios and examples
- Improve ICD-10-CM coding and HCC accuracy
- Learn tips on how to prepare for CMS RADV audits and greater federal scrutiny of clinical documentation and coding
Who Should Attend:
Outpatient and Inpatient coders, coding auditors and coding educators, HCC coding staff, clinical documentation integrity specialists (CDISs), coding compliance specialists and managers, hospital emergency department coders, compliance directors, physician office coding staff and revenue cycle managers.
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.