BC Advantage - 2024 Issue 1

Missing HCC Codes Leave Money on the Table

Improper clinical documentation of one patient can mean a difference of more than $10,000 in yearly estimated healthcare costs. How much money are you potentially leaving on the table?   Medicare/Medicaid and other insurance companies use Hierarchical Condition Categories (HCC) coding, a risk-adjustment (RA) model, to assign patients a Risk Adjustment Factor (RAF) score. They use this score to predict future healthcare costs and reimbursements associated with each patient on an annual basis. As a provider, you tell your patient's health story through medical coding and documentation. When done correctly, this not only provides the patient with better...

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