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by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA At the end of last year,  this news may not have caught your attention: Federal Auditor Renews Concerns of Medicare Advantage Gaming Axios, December 12, 2019 “A new federal audit presents more evidence that private Medicare Advantage plans are fudging the data about how sick […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE In case we need another reason to stand firm when documentation and/or coding become questionable, we are reminded that not only is it our duty, we may be subject to financial penalty if we do not. Earlier this year, Becker’s identified the failure of Medicare Part C […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE A recent article in Becker’s Hospital CFO Report entitled “Hospitals Overbilled Medicare $1B by Upcoding Claims, Inspector General Finds” caught my attention. The specific finding by OIG is that assignment of diagnosis codes for severe malnutrition to inpatient hospital claims (when they should have used codes for […]

by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA If you are wondering whether the documentation for a patient seen in the emergency department is relevant to HCC coding, the answer is an emphatic Yes! In fact, claims from the emergency department and any other outpatient hospital department qualify for HCC capture. These outpatient […]

by Rose Dunn, MBA, RHIA, CPA, FACHE, FHFMA In addition to the terrible human cost of the COVID-19 virus and the general impact it is having on the healthcare industry, there are two ways in which the pandemic may affect your HCCs. With people being told to stay home, the reduced number of visits to […]

How do you think healthcare organizations and other entities will use HCC data going forward? 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 […]

  by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA   I recently received an inquiry from a coder and she provided the following image: Click to enlarge The coder wanted to know why the same ICD-10-CM code would map to two different HCC codes. This is a great question! There are over 10,000 […]

by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA One unique aspect of HCC coding is that it requires provider documentation of HCC conditions each calendar year. As the holidays approach, we need to remember the annual HCC “reset” will be upon us January 1. Now is the time to prepare for the New […]

by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA As we all know, thorough and complete documentation is essential to support Hierarchical Condition Category (HCC) coding. But how do we know when the documentation is enough? I am seeing alarming reports of auditors rejecting HCC diagnoses based on what they are claiming is insufficient […]

by Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA We recently received a question regarding the use of problem lists to support HCC diagnoses: My question is regarding the documentation source for Inpatient. “Problem Lists’ are not considered a source to get the documentation, is that correct? Is there a website I can go […]

What new healthcare career opportunities do you think will emerge for coders who understand risk adjustment? 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 […]

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 […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE I recently received a question from a coder interested in HCC Coding: “Should a person be proficient in CPT and HCPCS coding in order to be an HCC coder?” The short answer is no: HCC coding is not reliant upon CPT or HCPCS skills. HCCs are based […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE and Laurie M. Johnson, MS, RHIA, FAHIMA     Join us for a discussion of HCCs by two industry leaders: Rose T. Dunn, MBA, RHIA, CPA, FACHE, and Laurie M. Johnson, MS, RHIA, FAHIMA.             Rose: So, Laurie, the last time we spoke, […]