The Value of HCC Coding for Medicare Advantage Plans

 A Medicare Advantage (MA) plan is an alternative for receiving Medicare Part A and Part B coverage. Medicare Advantage Plans, generally known as Part C, are provided by Medicare permitted private entities that must cling to Medicare's standards and restrictions.

The majority of Medicare Advantage Plans provide medication coverage (Part D). Medicare Advantage Plans are classified into various kinds. Some of these include:

Health Maintenance Organization (HMO) Plans

Preferred Provider Organization (PPO) Plans

Private Fee-for-Service (PFFS) Plans

Special Needs Plans (SNPs)

Medical Savings Account (MSA) Plans

Each one of these Medicare Advantage Plan types has its own set of restrictions regarding how patients receive the Medicare-covered Part A and B treatments, as well as the plan's additional perks. A participant in a Medicare Advantage Plan has the same protections and benefits as a participant in Original Medicare. However, the patients are always insured for emergency and urgent care in all kinds of Medicare Advantage Plans.

HCC Coding Is Important for Patients and Healthcare Providers

Hierarchical Condition Category (HCC Coding) aids in conveying patient complications and creating a holistic view of the patient. RAF scores are used to risk adjust cost and performance parameters to predict future health care resource use. Quality and cost performance can be assessed more accurately by adjusting for differences in patient complication.

As the RAF rises, so is the beneficiary's capitation compensation. It also impacts Medicaid managed care insurers, and Affordable Care Act (ACA) plans by delivering appropriate and effective diagnosis data for Medicare Advantage enrollees.

Why Is HCC Coding Vital for Healthcare Professionals?

The rise in health insurer adoption of value-based care models seems to influence clinicians' earnings directly. More excellent Risk Scores for a group equates to a more significant cost reference, whereas the exact opposite is true for relatively low-risk scores. That's why a precise and consistent risk score is required to achieve better savings.

Below are a few helpful suggestions for health practitioners:

1) Each chronic ailment should be evaluated at least once a year.

2) Specificity for diabetes, angina, pneumonia, kidney failure, chronic renal failure, and pressure ulcers should be documented—more excellent specificity results in a higher-weighted RAF score.

3) Specify the status of all diagnoses in the past (i.e., active versus a history of a condition).

4) All diagnoses that influence the person's assessment, management, and therapy must be reported, such as the present condition, concurrent acute disorders, and any chronic conditions.

5) It's worth noting that electronic claim forms enable physicians to include up to 12 diagnoses.