Explore the Hierarchal Condition Category (HCC) Content in EncoderPro

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Risk Adjustment Hierarchical Condition Categories (HCC Coding)

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Presentation transcript:

Explore the Hierarchal Condition Category (HCC) Content in EncoderPro Explore the Hierarchal Condition Category (HCC) Content in EncoderPro.com Attend this brief 30-minute overview of HCC content in EncoderPro.com and learn how to make your HCC coding more accurate and efficient. Ryan Devey

Disclaimer While the information provided in this presentation is believed to be reliable, Optum360® is providing this information for educational purposes only and not as a replacement for professional judgment and experience. Therefore, any use of this information is at your sole risk, and Optum360 neither assumes nor is responsible for its use and does not make any representation or warranty regarding the content of this presentation.

Today’s agenda Brief overview of HCC Level setting Driving in EncoderPro.com Actual application view and HCC in your current coding workflow: CMS HCC, HHS HCC CDI (Optum360 Support) HCC calculators

Brief overview of HCC Level setting

Brief overview of HCC (level setting) Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. Implemented in 2003, this model identifies individuals with serious or chronic illness and assigns a risk factor score to the person based upon a combination of the individual’s health conditions and demographic details. The individual’s health conditions are identified via the International Classification of Diseases-10 (ICD-10) diagnoses that are submitted by providers on incoming claims. There are more than 9,000 ICD-10 codes that map to 79 HCC codes in the Risk Adjustment model. CMS requires documentation in the person’s medical record by a qualified health care provider to support the submitted diagnosis. Documentation must: Support the presence of the condition and indicate the provider’s assessment and/or Plan for management of the condition This must occur at least once each calendar year in order for CMS to recognize that the individual continues to have the condition.

Driving in EncoderPro.com HCC coding within your existing coding workflow

Questions?

Physician Web-based Solution Product Manager Contact Information Ryan Devey Physician Web-based Solution Product Manager ryan.devey@optum360.com