HCC Risk Calculation

Improve outcomes, manage risk, ensure compliant coding, and maximize reimbursement with accurate HCC capture.

Since 2004, CMS has used a Hierarchical Condition Category (HCC) risk model to calculate health expenditure risk scores for Medicare Advantage (MA) enrollees. Because of the direct impact on health system revenues, correct HCC classification and risk calculation is essential for the preservation of an organization’s financial health.

However, the HCC classification process can be challenging. To ensure that HCCs are accurate, and that physicians are properly reimbursed, provider organizations need technology that streamlines the coding process and provides dashboard notifications about undocumented or improperly coded conditions.

As MA and other value-based reimbursement models continue to replace fee-for-service plans, providers can no longer rely on inefficient manual processes to calculate patient risk and flag documentation and coding gaps.

Topics discussed in this whitepaper include:

• Medicare Advantage
• Risk Sharing in MA Plans
• HCCs, RAF scores and Reimbursement Accuracy
• Workflow Challenges
• Documentation and Coding Inaccuracies = Money Left on the Table
• Fixing HCC and RAF Score Challenges
• Benefits of Assistive Technologies

Download this new whitepaper to learn more about optimizing point-of-care decision support for accurate HCC capture.

Schedule a demo to learn how Medicomp can help streamline your coding process and improve financial health.

FAQ

Q: What is HCC classification?
A: HCC classification is a process used by the Centers for Medicare & Medicaid Services (CMS) to calculate health expenditure risk scores for Medicare Advantage (MA) enrollees.

Q: Why is accurate HCC classification important?
A: Accurate HCC classification and risk calculation is essential for the preservation of an organization’s financial health, as it directly impacts health system revenues.

Q: Who should read this whitepaper?
A: Healthcare providers, administrators, and executives who want to optimize their point-of-care decision support and ensure accurate HCC capture to improve outcomes, manage risk, ensure compliant coding, and maximize reimbursement.