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HCC risk adjustment

HCC Risk Adjustment in Epic

Our health is the most important thing that we have.  Unfortunately, some of us suffer from more health problems than others, and as we all know, this can be expensive.  That’s why people turn to certain programs, such as Medicare and Medicaid, to help them cover the costs.  That being said, these programs also need to be able to predict healthcare costs of each of their patients, which they can do with HCC coding.

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So, what is HCC coding?  HCC, which stands for Hierarchical Condition Category, is a way to organize the hierarchical impact of conditions on a patient’s health, both as individuals and as a population.  The goal of HCC coding is to predict costs of care for the upcoming year.  HCC risk adjustment also better helps organizations understand the severity of illnesses that people have, and is able to separate certain illnesses and chronic condition diagnoses into categories with similar cost patterns.

HCC is scored by adding patient demographics with their diagnosis’ to get the HCC score/risk score.  The patient’s demographic considers age, gender, Medicare/Medicaid eligibility, and disability status.  The diagnosis of the person must be reported once per calendar year in order to be accurate.  For a physician to properly code for HCC, the condition of the patient must have been monitored, evaluated, addressed, and treated.

HCC coding is important because physicians can use these codes to increase quality, improve the patient’s experience, and receive appropriate reimbursements.  It also helps organizations understand the expected medical costs of a patient, which means they can use these scores to offer an accurate per-member/per-month fee to payers.

In order to get an accurate HCC code, physicians must use the right healthcare technology.  By using HCC risk adjustment in Epic, they’re able to understand the patient’s illness and needs better, which helps them to save resources and expenses. 

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