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.
To improve your HCC coding performance—and your success under value-based programs—implement these four best practices used by top-performing medical organizations.
1. Provider Education
Comprehensive physician documentation of a patient’s conditions in the EMR and robust diagnosis coding are the foundations of successful HCC coding. Unfortunately, providers are required to do more today than ever before, and can feel overwhelmed when asked to focus on HCC coding in addition to their many other responsibilities.
That’s why our most successful customers:
Educate providers on how value-based contracts work. When physicians understand how risk-based contracts work—and the importance of HCC coding—they’re more likely to invest the extra time needed to properly and fully document the conditions of patients who are sicker or have chronic conditions.
Engage a physician to champion HCC coding. Our customers have found that physicians are often more open to receiving HCC coding feedback through coaching sessions conducted by a medical peer rather than a member of a different team.
With any provider education initiative, it's important to target a select number of patient conditions. Using the “crawl, walk, run” approach, start by focusing on the patient conditions your providers are most likely to encounter daily. Identify the codes that are most often applicable to your group’s patients and specialties. Then ask your physicians to focus on these conditions first, rather than asking them to focus on all 86 HCC categories. (You might want to begin by taking a look at the top 10 most prevalent HCCs.)
2. Prepare for Each Patient Visit
Our top-performing customers have found that preparing physicians for complex HCC patients in advance of the appointment helps their providers more accurately and completely address chronic conditions and capture HCCs.
Using care coordinators to identify incoming patients with HCC conditions and sharing that information with your physicians is essential. The process can be done as part of the morning huddle or pre-day prep, or it can be done via alerts that are set in the EMR. Regardless of the method, providers are better able to diagnose, treat, and document patients when they are prepared.
3. Use Coding Experts
Once providers have addressed a patients’ conditions and documented their findings in the clinical notes, the next step is to ensure that the correct HCC codes are included on the claim.
This isn’t as simple as it sounds. Turning clinical documentation into HCC codes is complicated. Physicians are seldom expert coders and their time is extremely valuable.
Our most successful customers have found that using certified risk adjustment coders (CRCs) is the most reliable and cost-effective way to ensure consistent and accurate HCC coding performance. It also helps ease some of the administrative burden on physicians, allowing them to focus more time and attention on caring for their patients.
It’s important for the coder review process to be done concurrently rather than retrospectively. To minimize rework, duplication of efforts, and the need for alternate submission forms to adjust initial claims, coder reviews should occur before claims are submitted.
4. Implement Real-Time Reporting of Value-Based Performance
The financial aspects of value-based programs can be complex. There’s often significant lag time between when physician and coding activities take place and when the financial impact of those activities is realized. In many cases, bonus payments or reimbursements are not received until the following year.
Top performing organizations focus on the key drivers that are within the providers control and deliver real-time insights and reports to their doctors. This performance data needs to be updated weekly—or, at bare minimum, monthly—so changes based on those insights can be implemented quickly before opportunities are lost and problems grow.
Generating timely reports—and tying physician incentives to metrics that can easily be reported and shared—gives physicians and coders a better understanding of how well they are doing. This allows teams to continually improve operations and achieve greater success under value-based contracts.
HCC coding is the revenue engine that empowers organizations to make the investments needed to succeed in value-based care. Implementing an effective HCC coding program requires a disciplined and thorough approach, and is essential to strong financial and clinical performance under value-based reimbursement contracts.
RCxRules automated HCC coding software dramatically increases coder productivity by identifying and directing only those high-value encounters with HCC coding gaps to coders for review. All before a claim is submitted. Interested in learning how RCxRules can increase your HCC coding capture by 30%? Schedule a 1:1 Meeting