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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, […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE Good documentation is the best defense against a negative audit outcome. We often find ourselves grousing about Dr. X who never documents something or Dr. Y who notoriously doesn’t enter her notes until the end of the week. Have your chatted with your peers in other practices […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE Why are physician practices reluctant to code all conditions? I still see physician offices submitting claims with only four diagnoses (sometimes fewer). The limitation of linking four conditions to a test or service has been interpreted by some providers as a limit on the number of diagnoses […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE We recently received a note from a colleague: “I have a question about emergency room facility coding regarding hcc. If the pt comes in with headache or rash or other diagnoses such as injuries and the physician states pt has diabetes or hypertension but does not state […]

by Rose T. Dunn, MBA, RHIA, CPA, FACHE Are you surprised by the denials and audits your organization is experiencing? We shouldn’t be surprised but monitoring everything is tedious and time-consuming. Who has excess staff to do it all? Often we get caught up with all the day-to-day distractions that we forego the opportunity to […]