Wiki HCC = Big check from Medicare?

[twdevore]

I have a coworker in the office that is promoting HCC Risk Adjustment. She claims that Medicare will send us a big check every year for using the HCC ICD10 codes. I understand that higher risk will increase the level of E/M but find it hard to believe that Medicare will send us additional money at the end of the year. I can find nothing that states this is an actual thing.

Is she correct?

Also, with the new proposed E/M payment policy, will this HCC even affect payment if it passes?

Confused.

 

[CodingKing]

No, HCC score is for determining the amount the payer gets from the government, not how much the provider gets as that is based on contract with payer.

 

[rmwinder]

Sometimes your physician office may be in a contract with a Medicare Advantage company where they work in partnership to accurately capture all diagnosis codes on all their patients. Usually your office has to have a large patient membership with a particular MA plan (Cigna, UHG, Humana, etc) to qualify to have the MA plan to work with the office. These contracts may reimburse the physicians to work together with the plan to capture all HEDIS measures. I also believe that some contracts may have a provision for the MA plan to share with the physicians other monies later on. However, that is not a concern for the coders in the office. The coders should not ever code, or even have the appearance of capturing codes strictly for money. With that said, the MA plans have every right to work with the physicians and their staff to assess and reassess all chronic condition diagnosis codes on a yearly basis. Some (a lot) of diagnosis codes represent chronic conditions and are recognized to utilize more money and time on the physicians part. These codes are 'weighted' to use in a formula used by CMS to reimburse the Medicare Advantage plans to administer Healthcare to their patients.

This should only motivate a coder to accurately capture every condition that applies to a patient. That should also be the case with every patient regardless of their insurance.