The Value Of HCC Coding In Medicare Advantage Plans

Hierarchical Condition Categories (HCCs) are a prominent issue in healthcare, and there's no greater opportunity to explore the value of HCC coding for Medicare Advantage Plans than now.

HCC Coding is the Risk Adjustment (RA) technique utilized by the Centers for Medicare and Medicaid Services (CMS) to calculate yearly reimbursements for Medicare Advantage (MA) beneficiaries. HCC risk adjustment employs predictive analysis to estimate the cost of medical care coverage for a specific population based on the severity of their chronic conditions, risk factor, and status. CMS uses this method to calculate cost reductions for individuals registered with Accountable Care Organizations (ACOs), and HCC risk adjustment will evaluate which Practice Risk Group individuals will be assigned under the revised primary care program.

Accurate HCC Coding is Critical for Medicare Advantage Plans and Providers:

Correct diagnostic coding is indeed crucial, and it is essential for the correct risk adjustment as it promotes optimal provider compensation under value-based compensation. Consistently code to the highest specificity is a simple great method to adopt. Ironically, Electronic Health Records (EHRs) make this more difficult since the query list for diagnostic codes typically places nonspecific codes at the top of the priority list.

To address this issue, experts advocate compiling a list of HCC diagnostic top picks that can be conveniently shown for making a choice. Test to see whether the EMR can indicate diagnoses that match to HCC Scores. Collaboration with a professional medical coder can help to ensure precision in the frequent ailments listed as top picks, particularly for disease pairings such as diabetes and chronic renal disease.

Furthermore, the healthcare practitioners can generate a diagnostic utilization report to highlight the predominantly administered HCC diagnosis, and afterwards evaluate and amend the issue checklists to be as descriptive as possible for individuals with any of those diseases. Accurate HCC Coding is critical for effectively forecasting future healthcare spending for patients and guaranteeing adequate compensation for providers.

Medicare Advantage Plans Must fulfill Their Responsibilities

CMS stipulates that Medicare Advantage Plans cover all of the services that conventional Medicare covers, since it is completely dedicated to guaranteeing adequate Medicare Advantage Plan reimbursements. CMS is in charge of ensuring that Medicare Advantage Plans perform their roles and obligations, and it will definitely press the plans to maintain the quality which they must fulfill.

CMS also mentions that most MA Plans offered by Medicare-approved private companies, may include additional assistance such as oral care, ophthalmology, hearing, and fitness and wellbeing initiatives.