HCC Coding Definition Hierarchical Condition Category (HCC) is a risk adjustment model implemented by CMS in 2004 to estimate predicted costs for Medicare beneficiaries based on disease and demographic risk factors or simply, the category of medical conditions that map to a corresponding group of ICD-9 diagnosis codes. The Risk Adjustment HCC Edition continues the innoviHealth tradition of providing helpful tools and resources for healthcare providers.This unique compilation of coding essentials makes it easier to get the job done. ��7�}`������3C��-��s�k191p�z1�8�s0�Lj��`��Y�p�AN��CZ�S �/n���e6�0��d��D��p��V�{��~mc@�*$�l��0 x��B������. Ms. Brown's expertise in Compliance, Inpatient Coding, DRG's/MS DRG's, OIG & RAC Targets, Clinical Documentation Improvement, as well as Risk Adjustment/HCC coding round out her areas of focus at RMC. This is a must have for every coder and clinician on your team! This information will enable new participants to collect and There are many instances where CMS does not give clear guidance. ICD-10-CM Official Guidelines for Coding and Reporting FY 2020, ICD-10-CM Official Coding Guidelines for COVID-19 April 1, 2020 -September 30, 2020, CDI‐Pertinent Coding Clinic Updates - ACDIS 2019, 2008 Risk Adjustment Data Technical Assistance For MAOs Participant Guide, Anthem MRA Documentation and Coding Guidance: Diabetes Mellitus and Endocrine, Nutritional and Metabolic Disorders 2019, Cigna Medicare 2020 Best Practices and Guidelines For Risk Adjustment and ICD-10-CM Coding. Overview The Vice President of HCC Risk Adjustment is responsible for the oversight of risk adjustment and coding, and establishing and managing company coding guidelines, policy and procedures. Her experiences include front office management, billing and coding, and practice HCC Coding December 3, 2020 Fewer Patient Visits Due to COVID-19 Means Fewer HCC Opportunities It is no secret that the COVID-19 pandemic has uprooted life in 2020. To be successful and fully compliant, it takes proactiveness in identifying and preventing coding and auditing errors which may impact your health care organization’s revenue cycle. NEW Model with 86 HCC Categories. ��{�6�����B�/08`��(ϴ���� B���$u�6 B��iG �Ds��#�P All visits require a chief complaint to be clearly documented. Requirements: SECTION 2 TEST . CMS Guidelines on HCC Coding, Auditing and Regulatory RequirementsTrending 09/24/2020. coding experience spanning her 30+years in HIM. These HCC reviews are part of Moda Health’s quality review program. Risk Adjustment Basics 2019 Optum360, LLC 11 MS-DRG Compared to HCC There is an increasing need for hospital inpatient coders to learn the outpatient coding … OVERVIEW: ... Coding Guidelines HCC Coding Chart Note Documentation Quiz . HCC Coding Tips. Hierarchical condition category (HCC) coding is a risk-adjustment model designed to estimate future health care costs for patients. Attend all project trainings and audit feedback sessions. - HCCs are captured over the span of a year by documenting the highest disease categories for a patient’s conditions. endstream endobj startxref ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 Pages 112-116: The guidelines for coding outpatient records are very clear in the OCG. Includes a complete list of ICD-10 codes included in the CMS-HCC and Rx-HCC Models for PY 2020. Review and perform HCC coding at an average 2-3 charts per hour. %%EOF These guidelines are provided for use by hospitals/providers and provider-based office visits. In HCC coding, the risk adjustment coding professional codes all conditions for the episode of care like traditional coding. Risk Adjustment Coding and HCC Guide Chapter 1. HCC coding is the mechanism by which Medicare (CMS) measures an individual’s overall health and provides risk adjustment, which in turn determines the expected cost to care for that individual over the next year. Higher categories represent higher predicted healthcare costs, resulting in higher risk scores. 235 0 obj <>/Filter/FlateDecode/ID[<6312B5E40214154E969E97E7AEDB5514>]/Index[199 93]/Info 198 0 R/Length 150/Prev 666762/Root 200 0 R/Size 292/Type/XRef/W[1 3 1]>>stream ICD-10 to HCC Mappings . In addition to diagnoses, base year factors in… 01/10//2020 The general guidance in this document is not exclusive. January 2, 2020 affinia-health HCC Coding Tips. SECTION 3 Coding Guidelines and Conditions by Chapter according to ICD -10-CM MODULE 1: Chapter 1 & 2 Quiz … Implement these HCC coding and risk adjustment best practices, that the top-performing medical groups are using, to achieve superior results u nder value-based and Medicare Advantage programs today. However, continuous review of the health record documentation throughout the year is necessary to ensure all conditions have been considered and abstracted by the end of the year. ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 As expected, the weight is shifting away from the 2017 CMS-HCC model which is currently 50% of the blended risk score for 2020 with the 2020 CMS-HCC model and 50% of the risk score calculated with the 2017 CMS-HCC model. The Center for Medicare & Medicaid Services (CMS) uses a Hierarchical Condition Category (HCC) risk adjustment model to calculate risk scores. submit risk adjustment data in accordance with Centers for Medicare & Medicaid Services (CMS) requirements. Please be sure to review your ICD 10 book to determine if a secondary code is required. Because of COVID-19, CMS is allowing providers to use telehealth to conduct patient visits and submit their diagnoses, as long as the visit meets CMS guidelines for risk adjustment. On April 1, the Centers for Medicare & Medicaid Services (CMS) released the Final Announcement outlining changes to the HCC Payment model for Medicare Advantage Plans and PACE Programs for Payment Year 2020. Risk Adjustment HCC Coder/Auditor Training Course 2020 . h�bbd```b``q��� �ID����/�Hf'0,΢ "�߃�c�*�z�eo�M���O^�؜�`��`�s��R0) The 2021 ACDIS Pocket Guide is co-written by ACDIS’ CDI Education Director Laurie Prescott , RN, MSN, CCDS, CDIP, CRC, CCDS-O, and a practicing physician steeped in the latest physician documentation terminology, James Manz, MD, CCDS-O . ICD-10-CM guidelines, Coding Clinic guidelines, CMS guidelines). Properly assign ICD-10-CM codes following CMS, AHA, AHIMA and NCHS guidelines. Take the two hour course on-demand, or sign up for one of our live events with Q&A. ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 (October 1, 2019 - September 30, 2020) Narrative changes appear in bold text .