alb0421
New
If a properly documented HCC code was missed on a claim, can the claim be corrected/resubmitted to include said HCC code?
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Wiki HCC Code Missed
- Thread starter alb0421
- Start date
unicorn80
Guest
I'm just taking a guess here and maybe someone will correct me if I am wrong but if you miss an HCC code on a claim that claim will get denied and sent back to you. This is your opportunity when a claim is denied, of course, look at the reason for the denial and then proceed with making the necessary corrections and resubmit the claim. I'm not sure once the claim goes out if you can retrieve it, add the missing code and then resubmit the claim.
Jchrist3614
New
If you are a provider office submitting a claim and failed to capture a correct diagnosis, you can submit a corrected claim any time you want as long as its within the timely filing limits. If you are a health plan trying to capture HCCs, I think most health plans can add/delete HCCs and submit to CMS themselves or have a vendor do so. I know there are dates that play a factor here for specific calendar years etc. and I am not 100% sure on what those are.
Lyta2000
Networker
Claims don’t get denied for payment due to a missing HCC code. HCC have to do with building the RAF score for the patient which is used to risk adjust the premium paid per member per month to the Medicare Advantage plan the following year for that patient.
Pathos
True Blue
Correct, HCC coding and claims denials have nothing to do with each other as they are separate parts of how to handle coding.
Most Health Plans who participate in Risk Adjustment allow providers to submit additional HCC codes to the Health Plan through other means. The HCC codes on claims are more the first line of Risk Adjustment coding sent to CMS. If providers have the ability to provide missed HCC codes, the submission of these codes can benefit the Health Plan and the provider (if their Risk Adjustment contract share risk with the Plan). The Health Plan is then responsible for making sure the HCC codes are supported by MEAT or TAMPER, which can be done through coding audits, either manually or automatically.
Hope this is helpful.
pippsquike
New
Yes, a corrected claim can be made adding missed HCC and rebilled to payer. Same for correcting a wrong diagnosis (example: active cancer vs history of).