HCC Information
I was able to find an explanation and a coding tool quickly.
this website has everything you need:
https://www.univhc.com/providers.asp
on the page, you will see Medicare Risk Adjustment Model (HCC) and view #1-6
"The Centers for Medicare and Medicaid Services (CMS) have implemented a new risk adjustment payment system, called the Hierarchical Condition Category (HCC) payment model. The goal of the CMS-HCC Medicare risk adjustment is to pay Medicare Advantage (MA) and Prescription Drug Plans (PDPs) accurately and fairly by adjusting payment for enrollees based on demographics and health status.
The payment model relies on clinical coding (ICD-9-CM codes) gathered by providers and submitted by the health plans to CMS. HCC's lump 3,100 diagnoses from the ICD-9 system into about 70 diagnostic groups. For your convenience, Universal has developed an ICD-9 Coding Tool that groups diagnoses by CMS-HCC category, which is available on our website.
Appropriate reimbursement to the plan depends on complete and accurate diagnosis reporting. It is more important than ever that Providers update their documenting and coding skills, and improve on coding accuracy. Please ensure that the diagnoses submitted to the plan are fully supported by the member medical record, signature compliant and specified up to the fifth digit.
Important points to remember:
Member health status is calculated by CMS for each calendar year.
All diagnoses vanish on December 31. Chronic conditions must be re-evaluated, documented and billed to the Plan every year.
Patients must be seen by a PCP annually (preferably every six months). Members that have not been seen have no diagnoses.
All new patients must be established with their PCP within 60 days of being assigned an order for CMS to collect accurate member diagnoses. A monthly membership list is available for PCPs to download under the “Provider Login” menu on Universal's website,
www.univhc.com
Be sure to report the claims and encounter information in a timely manner, generally within 30 days of the date of service. Universal Health Care is contracted with Emdeon (formerly WebMD) to facilitate EDI claims submission. Our provider number is 50528.
Providers are required to alert the Plan of any erroneous data submitted and follow the Plan's procedures for correcting erroneous data.
If you would like to learn more about the new risk adjustment model you can contact Universal Health Care Medicare Risk Adjustment team at (727) 456-2951 or (727) 456-6503."