Hierarchical Condition Categories (HCCs) are a hot topic when discussing risk assessment and payment for the long term care of our 65 and older patient base. Medicare Advantage enrollees are provided ongoing care reimbursement based on a specific set of demographics and diagnosis code data submitted to the payer over the course of time.
As auditors we find ourselves facing the challenge of educating our Providers on the importance of documentation that is both accurate and complete in order to produce the proper risk assessment. If a patient has multiple chronic conditions, it’s critical that all underlying health problems are reported annually to provide an overall view of the patient’s care situation.
To help you navigate the often confusing risk assessment process, Swiftaudit now includes an easy to use HCC lookup as well as a basic ICD-10 risk score calculator.
Preliminary risk scores can be accessed directly from the list of CPT related diagnosis codes in each Encounter.
Or you can view HCCs and calculate risk scores from the Coding Tools option in the upper navigation.
Our HCC lookup screen will display the appropriate category cross reference to your diagnosis codes, as well as the risk factor associated with each.
As always, we’ll continue to keep an eye on current audit trends and needs in order to provide the best possible tool set for our auditors and the clients they service!
For more information on how risk assessment and scoring works, check out Dr. Tom’s blog post on Calculating RAF Scores.