How precise HCC documentation can improve reimbursement

How much does specificity matter? When it comes to Medicare Advantage reimbursement, it matters. A lot.
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Whatever the industry, we all want to get paid for the work we do. For healthcare providers in the US — particularly those treating Medicare Advantage patients — the key to securing the right reimbursement lies in both understanding and correctly billing for Hierarchical Condition Categories (HCCs).

Accurate HCC coding helps to create a more complete picture of a patient population, improves the value of medical problem lists, and enables better management of chronic conditions. But improving the process of HCC capture and precise documentation can also dramatically impact CMS payments, as illustrated below.

Diagnosis ICD-10-CM HCC Premium Bonus
Diabetes with no complications E11.9 19 $894.40
Diabetes with diabetic neuropathic arthropathy E11.610 18 $1094.40
Diabetes with hyperosmolar coma E11.01 17 $1094.40
Diabetes with ESRD E11.22, N18.6 18, 136 $1273.60
Diabetes with ESRD on chronic dialysis E11.22, N18.6, Z99.2 18, 136, 134 $1475.20

Learn how to best manage HCCs in your EHR by downloading IMO’s white paper, “Get the right reimbursement for high risk patients.”

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