HCC Coding services

The HCC model assigns a Risk Adjustment Factor (RAF) score to each patient basis patient’s demographics and diagnoses, which is a relative measure of how costly that patient is anticipated to be. According to the ‘American Academy of Family Physicians’, “hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient,” helping to appropriately measure quality and cost performance. Reporting a complete picture for the risk adjustment factor increases the accuracy of the patient score and ideally reduces the need to request medical records, prevents audit provider’s claims and allows fair compensation for services rendered. Capturing HCC diagnoses across the continuum of care to reflect the total disease burden of a patient population not only benefits the patient but also provides important information for physicians and payers.

At CureMed Solutions,  

• Our coders with multiple years of experience in HCC coding have a comprehensive understanding of all the key components related to retrospective and prospective risk adjustment chart reviews, adhering to official coding rules and CMS guidelines on reporting for risk adjustment
• They have expertise in picking up all relevant ICD-10 codes for risk adjustment, ensuring that highest degree of specificity is assigned to each diagnosis and MEAT criteria is met for all diagnosis mentioned in documentation.
• We conduct compliance audits and detailed chart reviews to detect risk adjustment coding inaccuracies or missing diagnoses affecting "Risk-Adjustment Factor" (RAF) score.
• Our CDI specialists also suggest recommendations to providers on documentation best practices such as concepts of ‘cause and effect’ relationships, linking complications and manifestations of a disease process, when and when not to document “history of” diagnoses etc. to provide opportunities for improving HCC coding.