Medical Reimbursement Specialist
Medicare Risk Adjustment Data or Hierarchical Condition Categories (HCC)
- 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. Ten points for cancer plus 1 point for pneumonia plus five points for asthma yields 16 points)
- 2007 was the first year for reimbursement 100% based on this Risk Adjustment Data
What you can do today -
- 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.
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Reimbursement Specialist
4012 Katella Avenue, Suite 105
Los Alamitos, California 90720
Tel: 562-430-6847
Fax: 562-430-6849
Email: Info@reimbursementspecialist.com
©2007 Reimbursement Specialist All rights reserved.