Best Practices to Achieve HCC Compliance

Hierarchical condition category (HCC) coding is the foundation of the CMS’s risk-adjustment payment model, which is intended to help better project future cost of care for certain Medicare Advantage, Medicaid and ACA members with acute or chronic conditions. HCC coding provides a complete picture of the member’s health and is also critical in ensuring that they are effectively managed through a plan’s care management program. An oversight of a substantiated diagnosis code means the member will not be flagged for intervention, nor will the plan be reimbursed at a rate appropriate for the care the member needs.

When properly applied, HCC codes can improve health outcomes, reduce costs for health plans, and ensure providers are accurately compensated for the appropriate level of care for high-risk members.

Download the white paper to learn ways health plans and providers can improve HCC coding, reimbursement and health outcomes.

Download the Whitepaper