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AAPC HEALTHCON Las Vegas, NV April 28–May 1, 2019 Explore the Hierarchal Condition Category (HCC) content in EncoderPro.com
AAPC HEALTHCON Las Vegas, NV April 28–May 1, 2019
Explore the Hierarchal Condition Category (HCC) content in EncoderPro.com
© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
Today’s agenda
Brief overview of HCC • Level setting
High-level view of HCC in EncoderPro.com • Screenshots
Driving in EncoderPro.com • Actual application view and HCC in your current workflow − CMS HCC, HHS HCC − CDI (Optum360 Support) − HCC calculators
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Level setting
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© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
Brief overview of HCC (level setting)
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Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. Implemented in 2003, this model identifies individuals with serious or chronic illness and assigns a risk factor score to the person based upon a combination of the individual’s health conditions and demographic details. The individual’s health conditions are identified via International Classification of Diseases–10 (ICD-10) diagnoses that are submitted by providers on incoming claims. There are more than 9000 ICD-10 codes that map to 79 HCC codes in the Risk Adjustment model. CMS requires documentation in the person’s medical record by a qualified health care provider to support the submitted diagnosis. Documentation must: 1. Support the presence of the condition and indicate the provider’s assessment
and/or 2. Plan for management of the condition. This must occur at least once each calendar year in order for CMS to recognize the individual continues to have the condition.
Screenshots
High-level view of HCC in EncoderPro.com
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© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
HCC in EncoderPro.com — screenshot
HCC types
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© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
HCC in EncoderPro.com — screenshot
HCC categories-to-code crosswalks and hierarchies
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© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
HCC in EncoderPro.com — screenshot
HCC categories-to-code crosswalks and CDI
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© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
HCC in EncoderPro.com — screenshot
CDI support
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© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
HCC in EncoderPro.com — screenshot
Identifying HCC codes in your normal coding process
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© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
HCC in EncoderPro.com — screenshot
Categories tied to codes
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HCC coding within your existing coding workflow
Driving in EncoderPro.com
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Questions?
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AAPC HEALTHCON Las Vegas, NV | April 28–May 1, 2019
Thank you. CONTACT INFORMATION
Physician eSolutions Product Manager Optum360 [email protected]
Ryan Devey
