As a Certified Risk Adjustment Coder (CRC™), you’re an advocate for payers, providers, and patients. By Richard “Rik” Salomon, CPC, CRC HCC (hierarchical condition category) coding affects payers, providers, and patients in every setting. But capturing HCC codes in the emergency department (ED) is complicated because of the urgency to process patients quickly. Primary care ...
Train radiologists and physicians to work together to capture this deadly disease in the medical record. By Mary E. Wood, CPC, CPC-I There are certain hierarchical condition categories (HCCs) that specialists feel comfortable capturing, which include hypertension, diabetes, and chronic kidney disease. The manifestations of all three of these diseases find their way into multiple ...
In CMS
Apr 13th, 2018
The Centers for Medicare & Medicaid Services (CMS) put on display April 9 a rule that finalizes several proposed changes that will significantly expand the role of states in the administration of the Patient Protection and Affordable Care Act (PPACA), with the intention to reduce regulatory burden and increase flexibility. Background of the PPACA President Obama ...
Help physicians fill in the missing information when they use visual cues to determine a diagnosis. Most coders are familiar with the coding and documentation guidelines required to support the management of hierarchical condition categories (HCCs); for certain conditions, however, physicians may use visual cues to decide whether the patient’s diagnosis is appropriate. This can ...
In Billing
Feb 2nd, 2018
Small group and individual markets have unique strategic opportunities for coding and operational processes. Risk adjustment is predictive modeling that assesses members’ risk for incurring medical expenses above or below the average during a defined time. Demographics and health status are used to determine health plan payments, which also can assist with care management needs. ...