Helping Your Organization Receive the Maximum Reimbursement to Care for Your Medicare Advantage Population
It is critical for providers to accurately capture Hierarchical Condition Categories (HCC) on an annual basis that reflects the health status of the patient to maximize revenue. Optimizing HCC helps the practice, payers, and patients.
Due to the complexities of Medicare Advantage and value-based care, many healthcare organizations need assistance navigating HCC documentation and guidelines. CTG's experienced, dedicated team can help you overcome common challenges, such as:
Lack of Provider Training
High Usage of Non-Specific Codes: Improving HCC coding at point of care
Inadequate Documentation: Ensuring documentation supports the level of HCC code and patient conditions
Anxiety Over Alerts: Lack of knowledge and usage of BPA/CDS alerts
Inefficient Provider Panel Management
Cumbersome Patient Allocation
Ineffective Problem List Management
Insufficient Monitoring or Availability of HCC Data
Lack of Outreach for HCC Recapture
HCC Software Not Optimized
What is HCC?
Hierarchical condition categories—HCCs—are 86 sets of medical codes linked to specific clinical diagnoses.
HCC coding is used to assign patients a risk adjustment factor (RAF) score. Healthier patients have a lower score while less-healthy patients have a higher score. RAF scores help scale payments to reflect a patient’s risk (i.e., higher risk = higher future costs = higher payments).
The Centers for Medicare and Medicaid Services uses HCC to identify Medicare Advantage patients with serious acute/chronic conditions to estimate future healthcare costs.
hcc implementation offerings
Medicare Advantage and managing risk is not just about HCC codes. We meet you where you are by assisting the practice with a well-rounded solution and strategy to maximize reimbursement and expand care for high-risk patients.
CTG provides the following support during a typical HCC activation/optimization project:
Update Diagnosis Content
Activate or Optimize HCC Software
Requirements for Regulatory Compliance
Develop Processes to Manage Problem Lists
Implement Management Strategy and Build of Registries
Develop Metrics for Reporting, Dashboards, and PDSA Cycles
Advance HCC Roles and Workflow
Ensure Documentation Supports HCC Coding
CTG also offers the following support services, if requested:
Provider and Staff Education
Medicare Annual Wellness Management
CTG has extensive experience with the following training options and can customize based on a client’s needs:
Self-Directed E-Learning Modules or Practice Exercises
E-learning, Webinars, Instructor-Led Content
In-Person, Hybrid, or Virtual Training
CTG's Jeanette Ball explains how close adherence to the HCC model provides three key advantages: better funding, improved patient services, and optimized care costs. Check out the blog to learn more.