Medical Reimbursement Specialist

Medicare Risk Adjustment Data or Hierarchical Condition Categories (HCC)

ICD-10 will be in effect on October 1, 2013!

Call our office today to prepare for the transition. If you have a high percentage of Medicare Advantage patients, being prepared for this transition is crucial to your continued healthy bottom line.

What is a CMS-HCC Chart Review?

Some chart reviews are done to ensure that deserved reimbursement reaches your practice. The HCC Chart Review is one example.

Through a CMS-HCC chart review, the reviewer gleans out of your documentation those codes that may have been missed; or that may have been omitted from the encounter data submission; or that you may have been unaware merited a separate condition code. Submitting these by the deadline date guarantees that your payments will reflect deserved increases in reimbursement.

As part of the process, you will receive tips on how to improve your documentation to support the diagnosis code assignment.

Your 2010 payments for patients in a Medicare Managed Care plan were based on the diagnoses submitted for those patients in 2009. Likewise, your 2011 payments will be based on what is submitted for 2010 dates of service.

Our staff of certified coders are experienced in abstracting charts for this vital information. We have extensive experience in providing bilingual (Enlish/Spanish) guidance in this area.

How does CMS-HCC work?

Health status eventually replaces demographics factors as adjustment
Focal point is complete and accurate coding
Multivariate models sum points or weights for multiple factors to score an enrollee
Each enrollee gets a score based on which factors were present (e.g. 10 points for cancer plus 1 point for pneumonia plus 5 points for asthma yields 16 points)
2007 was the first year for reimbursement 100% based on this Risk Adjustment Data. Payments for Medicare Advantage patients have been based entirely on the diagnosis coding assigned by you!

What you can do today -

Initiate a task force to start addressing the transition to ICD-10

Provide education for all providers on appropriate documentation

Provide to all providers this handy Physician's Handout: HCC**

Train in-house coders to recognize HCCs while abstracting

On-going audits addressing HCC coding and documentation

Implement feedback mechanism for continous improvement

Get a baseline audit for your group and improve revenue

Access a complete list of HCCs directly from Medicare here: HCC.

** The HCC handout is also available with RAF or Category. Please call the office to request: 562-430-6847.