Contents
- 1 What does HCC mean after a medical diagnosis?
- 2 What is an HCC diagnosis?
- 3 Is HCC coding hard?
- 4 How is HCC risk score calculated?
- 5 What is the purpose of HCC coding?
- 6 What does HCC risk code mean?
- 7 What does hierarchical condition categories ( HCC ) stand for?
- 8 How is a HCC score calculated for a patient?
- 9 What is the difference between CMS-HCC and HHS HCC?
- 10 What is a good HCC score?
- 11 How is an HCC score calculated?
- 12 What is the new model of CMS-HCC?
What does HCC mean after a medical diagnosis?
An Introduction to Hierarchical Condition Categories (HCC)
What is an HCC diagnosis?
A Hierarchical Condition Category (HCC) is defined as a risk adjustment model that is used to calculate risk scores to predict future healthcare costs. The Centers for Medicare and Medicaid Services’ (CMS) CMS-HCC model is used to predict healthcare spending for Medicare Advantage Plan enrollees.
What does HCC mean after a name?
Hierarchical Condition Category
HCC stands for Hierarchical Condition Category. It refers to a system of medical coding used by insurance companies to determine patients’ future medical needs for the next year.
What is a good HCC risk score?
Risk scores generally range between 0.9 and 1.7, and beneficiaries with risk scores less than 1.0 are considered relatively healthy.
Is HCC coding hard?
If experienced medical office workers struggle with HCC coding, how hard will it be for someone with no experience? The difference is in the training. Although few can simply sit down and begin HCC coding, the training is very straightforward.
How is HCC risk score calculated?
The CMS-HCC risk score for a beneficiary is the sum of the score or weight attributed to each of the demographic factors and HCCs within the model. The CMS-HCC model is normalized to 1.0. Beneficiaries would be considered relatively healthy, and therefore less costly, with a risk score less than 1.0.
How many HCC models are there?
There are two different models for Hierarchical Condition Category (HCC) risk adjustments. The U.S. Department of Health and Human Services (HHS) oversees the HHS-HCC risk adjustment model 2020, which covers commercial payers of all ages and determines risk payments for the current year.
What does meat stand for in HCC coding?
Applying the culture of MEAT to HCC logic and making sure it is in the documentation is the most effective way to ensure HCC coding accuracy. First, let’s define MEAT: Monitor—signs, symptoms, disease progression, disease regression. Evaluate—test results, medication effectiveness, response to treatment.
What is the purpose of HCC coding?
What is HCC Coding? Hierarchical Condition Category coding, or HCC Coding, was first implemented by the Centers for Medicare and Medicaid Services (CMS) in 2004, as a way for medical groups to estimate a patient’s future health care costs in value-based payment models.
What does HCC risk code mean?
Risk Adjustment and Hierarchical Condition Category
Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. CMS requires documentation in the person’s medical record by a qualified health care provider to support the submitted diagnosis.
What does HCC stand for in medical coding?
At the moment, every coding leader and the commercial payer is talking about HCC. It is clear that proper HCC medical coding and documentation is critical in ACOs, MA, and HVBP. In order to ensure HCC codes and documentation compliance, CMS checks health plans using targeted and random audits.
How are HCC’s used in the Medicare system?
Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions. This allows Medicare to project the expected risk and future annual cost of care.
What does hierarchical condition categories ( HCC ) stand for?
The Hierarchical Condition Categories (HCC) is a risk-adjustment model that has existed for many years. With the introduction of the Medicare Advantage Plans and its requirement of RAF reimbursement scores, the HCC has become more popular. At the moment, every coding leader and the commercial payer is talking about HCC.
How is a HCC score calculated for a patient?
Each HCC associated with a patient is assigned a relative factor that is averaged with any other HCC code factors and a demographic score. The resulting score is then multiplied by a predetermined dollar amount to set the per-member-per-month (PMPM) capitated reimbursement for the next period of coverage.
Hierarchical Condition Categories
HCCs, or Hierarchical Condition Categories, are sets of medical codes that are linked to specific clinical diagnoses. Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions.
What is a HCC condition?
Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. Hierarchical condition category relies on ICD-10 coding to assign risk scores to patients. Each HCC is mapped to an ICD-10 code.
What is COPD type CMS-HCC?
Not all ICD-10-CM codes map to an HCC….Table 2.
| HCC | Category Description | Relative Factor |
|---|---|---|
| 111 | COPD | 0.335 |
| 112 | Fibrosis Of Lung and Other Chronic Lung Disorders | 0.216 |
| 114 | Aspiration and Specified Bacterial Pneumonias | 0.612 |
| 115 | Pneumococcal Pneumonia, Empyema, Lung Abscess | 0.164 |
What is the difference between CMS-HCC and HHS HCC?
“Code all documented conditions, which coexist at the time of the visit that require or affect patient care or treatment….How to use this information in practice.
| CMS-HCC | HHS-HCC |
|---|---|
| Developed for >65 year olds and disabled patients of all ages | Developed for all age patients |
What is a good HCC score?
What time frame is used for the CMS HCC system?
Reporting time frame HCCs are calculated over a year, using scores from all providers that have treated the patient in that time. MS-DRGs capture one inpatient encounter at a time and for one single provider at a time.
What does CMS-HCC apply to?
HCC Coding 101 CMS uses HCCs to reimburse Medicare Advantage plans based on the health of their members. It pays accurately for the predicted cost expenditures of patients by adjusting those payments based on demographic information and patient health status.
How is an HCC score calculated?
There are relative factors associated with each HCC and interaction. Sum of Factors Demographic + Disease = raw risk score The relative factors for all of the demographic variables, HCCs, and interactions are added together. The result is the raw risk score.
What is the new model of CMS-HCC?
The new model is referred to as CMS-HCC and is based on chronic health conditions. Doctors must give thorough reports on the risk adjustment of each patient and based on the documentation of clinical medical record from face-to-face encounters. Consequently, the RAF cannot be entirely determined by the patient’s test results or medical history.
How are hierarchical condition categories ( HCC ) used in Medicare Advantage?
Hierarchical condition categories (HCCs) CMS developed HCCs to pay Medicare Advantage Organizations (MAOs) differentially based on disease burden and demographics. Some payers use proprietary risk adjustment models, but HCCs are well known. About 9,000 ICD-10 codes are grouped into categories and these categories are assigned a risk factor.
How does the HCC payment system work and what does it mean?
The HCC payment system uses ICD-10 codes and demographics to generate a risk adjustment factor (RAF) score which identifies patients that require a higher cost to care and is based on the diagnosis codes billed in the previous review period.