HCCs are sets of codes that are linked to specific diagnosis codes. Risk adjustment coding is an important component to forecast expected healthcare costs. HCCs were first developed in 2004 and used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk adjustment model that identifies individuals with acute and chronic conditions that require more resources to manage their care. Risk Adjustment is the process in which health plans are equitably reimbursed based on the expected cost to care for its members. Accurate coding and documentation is a component of risk adjustment. HCCs are used by Medicare, Medicaid, and other commercial payors to forecast risk. Each HCC represents a diagnosis with similar clinical complexity to project expected risk and forecast annual cost of care. Practitioners have an important role to play in risk adjustment. Risk Adjustment means that the documentation should capture the patient’s full health story, including all of the conditions that may affect how they are managed and/or treated.

HCCs are used to calculate payment to healthcare organizations for patients insured by Medicare Advantage plans, some Affordable Care Act plans and Accountable Care Organizations. This webinar is presented in two parts to capture the HCC (risk adjustment) basics and how documentation plays a key role in HCC coding.

What you will learn:

• Review HCC’s and how risk adjustment affects payment.
• Identify Medicare Risk Adjustment Principles
• Recognize how the problem list affects HCC assignment.
• Review medical record documentation and how HCCs affect compliance and payment.
• Identify common coding and documentation errors that affect the HCC assignment.
• Develop a list of actions that can be taken to enhance clinical documentation and support the care provided for the patient’s conditions.