HCC Coding: Delivering Medical Coding Expertise to Insurers
Ovation Revenue Cycle Services’ Hierarchical Condition Category (HCC) Coding Service brings medical coding expertise to the insurer. Our HCC coders code thousands of records each week in compliance with the Medicare Risk Adjustment payment model introduced by the Centers for Medicare and Medicaid (CSM). This Risk Adjustment payment model measures the disease burden that includes 70 HCC codes which are correlated to diagnosis codes.
HCC models are specialized to Medicare Advantage (MA) plans which capture and report acute and chronic ICD-9-CM diagnosis codes to CMS annually. Diagnoses from the previous year are used to assess, pay and adjust payments to the MA plan for the cost of taking care of its members.
The model includes 3,000 ICD-9 diagnosis codes that are grouped into 79 categories. A patient may have diagnoses resulting in multiple HCC’s, categorized by the most severe manifestation among related conditions. HCCs are cumulative so each additional diagnosis can result in increased payment to the MA plan. Therefore, complete and accurate documentation is necessary from the providers to validate all codes on a yearly basis.
The submitted codes must come from an acceptable provider during a face-to-face encounter. These include physician visits and hospital inpatient and outpatient stays. For example, a patient may have an annual check-up for diabetes, angina and chronic obstructive pulmonary disease which would all be submitted as valid HCC diagnosis codes. Chart reviews by an Ovation RCS HCC coder will ensure all relevant HCC codes were documented and submitted.
Ovation coders have expertise in HCC Coding, CPT, HCPCS, ICD-9, and ICD-10 coding for inpatient and outpatient claims, including all major clinical specialties. Each coder receives extensive medical record coding, HIPAA, and LMRP compliance training and review to assure accuracy standards are achieved. Quality assurance teams monitor ongoing coder accuracy in assigned diagnosis codes, CPT codes, DRGs, CC, and MCC conditions assigned, proper use of modifiers, appropriateness of medical record supporting documentation, and customer and insurance specific directives.
To learn more about Ovation Revenue Cycle Services’ Comprehensive Coding Services, visit www.ovationrcs.com.