When it comes to getting the right reimbursements, ensuring accurate capture of Hierarchical Condition Categories (HCCs) is paramount. However, it can be challenging for clinicians to do so within their current EHR workflows.
In our on-demand webinar, How to better identify HCCs in the EHR, IMO experts June Bronnert MHI, RHIA, CCS, CCS-P, Senior Director of Informatics, and David Arco, Senior Project Manager, discuss ways that institutions can improve HCC capture. But for those who prefer a quick recap, we’re breaking out five key takeaway points below.
1. HCCs are re-evaluated on an annual basis
For clinicians, billing departments, and others who document HCCs, this means that keeping up with new changes and regulations is critical. Rates for the upcoming year are finalized every April, and the previous year’s patient data is used to determine new rates.
2. HCCs are becoming more holistic
In 2023, be on the lookout for changes to the way HCCs are calculated to include topics like social determinants of health and quality measures for health disparities. Patient reviews and complaints about providers will also become more important.
3. HCCs are multifaceted and can be complex
With 85 categories, keeping everything straight when it comes to HCC capture is understandably difficult. However, some fast facts can help – multiple hierarchies can apply to a single patient, HCC capture uses ICD-10-CM terminology as its foundational standardized code system, and financial reward is tied to increased specificity.
4. Documenting HCC management is critically important
Documenting a disease or disorder – even with the appropriate amount of specificity – is only one facet of ensuring correct reimbursement for treating HCC patients. Documentation of the interventions or measures taken to treat the condition provides additional information to claims and helps care qualify for HCC status.
5. Unaddressed HCCs leave clues throughout a patient’s chart
For health organizations striving to improve their HCC capture, starting with an understanding of addressed and unaddressed HCCs is an excellent first step. However, to find unaddressed HCCs, providers need to know what they are looking for. Pay close attention to lab results, changes to medications, new vitals, and unstructured notes for important clues hidden in the patient chart.
