explore the hierarchal condition category (hcc) content in ......brief overview of hcc (level...
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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