Will all Coders Eventually Need HCC Training?
Hierarchical Condition Categories (HCCs) are utilized by Medicare Advantage and Affordable Care Act payers for approximately 30 million individuals currently. Use of HCCs is projected to grow significantly in coming years and individuals with in-depth knowledge and command of the HCC system will be needed to ensure coding is accurate, supported by documentation, and that reimbursement is appropriate. We asked six experts what they thought about the challenges and opportunities provided by the accelerating move toward risk adjustment payment models.
In the third installment of this discussion, several of the experts discuss whether all medical coders will eventually need to be trained in HCC. (See the series in its entirety here.)
“…it’s just a matter of time before risk adjustment sweeps across all payers. Physicians, CDI specialists, coding auditors, and managers will all need various levels of HCC training.”
-Bonnie S. Cassidy
DUNN: I believe all coders will need this training because risk adjustment is ICD-10-CM-based, and diagnosis code-driven reimbursement occurs in all care settings—inpatient, outpatient, and ambulatory care.
CASSIDY: Yes, I think it’s just a matter of time before risk adjustment sweeps across all payers. Physicians, CDI specialists, coding auditors, and managers will all need various levels of HCC training.
“By 2020, 75% of the population will be in some type of value-based plan.”
MALONE: I agree. Value-based care is not going away. It’s here to stay. As of 2019, far more Medicare Shared Savings Program ACOs are in or will be moved to contracts with two-sided risk. Previously, less than one percent were in a shared-risk arrangement, which meant that almost all of these ACOs didn’t need to repay money for poor performance. By 2020, 75% of the population will be in some type of value-based plan.
“I think the question is more about whether coders need training on how to follow the coding guidelines, and the answer is that they do.”
MURPHY: I think the question is more about whether coders need training on how to follow the coding guidelines, and the answer is that they do. If coders follow the guidelines, it shouldn’t matter what payment methodology is in place. Risk adjustment training is great for those coders who want to make more money or move into other positions.
JOHNSON: It would be advantageous for everyone to have HCC training because we need accurate and comprehensive HCCs. Some physician coders only report four diagnoses on the 1500 claim form even though they can technically report up to 12. Hospital coders can report up to 25 codes on the UB-04 electronic claim. This deficiency affects the quality of physician data.
Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, President of Cassidy & Associates
Rose T. Dunn, MBA, RHIA, CPA, FACHE, Chief Operating Officer, First Class Solutions, Inc.
Laurie M. Johnson, MS, RHIA, FAHIMA, Senior Healthcare Consultant, Revenue Cycle Solutions, LLC
Donna Malone, CPC, CRC, Director of Coding and Provider Education, Enterprise Risk Adjustment, Tufts Health Plan
John Murphy, MBA, Principal, Risk Adjustment Consulting
Earshler Taylor, RHIA, RHIT, CCS, CDIP, CPC-I, COC, CPC, Chief Executive Officer, Earshler Taylor Consulting
Lisa A. Eramo, MA, moderator and freelance writer
Fundamentals of HCC Coding
Go beyond just the diagnoses — really understand the methodology behind HCCs! Prepare for the future of healthcare reimbursement with “Fundamentals of HCC Coding,” by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE. Learn more here.