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Glossary Terms

What is Hierarchical Condition Category (HCC) Coding?


Hierarchical Condition Category (HCC) Coding attempts to address the full patient diagnosis profile better, including the complexities of diagnostic and treatment realities. By utilizing different healthcare models, the Centers for Medicare & Medicaid Services (CMS) can better predict the level (and cost) of care they’ll need now and in the near future. Medicare Advantage programs are paid based on the health conditions of their patients, which are delineated through HCC codes. This is instead of the traditional fee-for-service based model where payments are based on services rendered.

With more than 20 million American patients involved in the Medicare Advantage Plan, HCCs have become even more important in determining patient cost and reimbursement. Practices can also prep for the inevitable risk exposure of HCC coding and audits by conducting a NextGen EHR Audit with consulting assistance from TempDev’s experienced team. 

What is Hierarchical Condition Category (HCC) Coding? 

HCC coding is just one of the risk-adjustment models used to calculate healthcare costs. This HCC coding model has been around since 2004. It was initiated by the Centers for Medicare & Medicaid Services (CMS) in 1997 to reflect value-based care models better. Beyond the complexities, HCC coding also takes into account the quality and cost variables for the practice. 

What Are the Benefits of Hierarchical Condition Category (HCC) Coding?

Hierarchical condition category (HCC) coding allows practices to better demonstrate the complexities of their patients’ needs. As a physician fully details out the patient's diagnosis conditions that they are treating utilizing HCC codes, the “big” picture of the cost and complexity of treating the patient becomes tangible. By participating in Medicare Advantage plans, providers are incentivized to be cognizant of outcomes and incentivized to do so rather than having reimbursement based upon services rendered.

Practices can’t afford to lose sight of the importance of effective and accurate annual HCC coding on medical billing claims. This ensures the accuracy of each patient’s medical record, and physicians are more likely to receive accurate reimbursements that cover the cost of the quality care they offer their patients. TempDev helps you prepare for any issues with coding, appointments, documentation, and overall workflow with clinical audits to ensure the accuracy of your EHR systems. 

How TempDev Can Help You With RCM

TempDev’s team of experienced consultants, developers, and trainers are here to support enhanced accessibility, as well as customized features and templates. This enables you and your patients to have more control over data with improved transparency. By focusing on proper HCC coding, practices receive higher reimbursements, and patients receive more accurate medical records and treatments. TempDev helps you prepare for any issues with coding, appointments, documentation, and overall workflow with clinical audits to ensure the accuracy of your EHR systems. 

As part of our streamlining process, we help you implement the Patient Portal, API, and other tools to better support safety, patient engagement, and security. From dashboards to automation and workflow redesign, TempDev offers the comprehensive resources and tools you need to ensure compliant annual HCC coding.

Contact us here or by calling us at 888.TEMP.DEV to begin discussing improving your HCC Coding and RAF scores.


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