HCC Coding Tool

Why do you need HCC Coding Tool:

Beginning in 2018, physicians and other providers will have their future Medicare reimbursement adjusted by the results of Medicare efficiency measures, which are categorized as the Resource Use Measures in MIPS, the CMS Merit-based Incentive Payment System. Resource Use Measures look at the global (Medicare Parts A and B) cost of services (resources) used for the patients attributed to the physician, and compare the resources used on a risk-adjusted basis to norms determined by CMS. Examples of Resource Use Measures include Total Per Capita Cost, Medicare Spending Per Beneficiary, and new Episode of Care measures, most of which are specific to patients with identified conditions (for example, Ischemic Stroke or Osteoporosis) and specific services (for example, Coronary Artery Bypass Graft, Pacemaker, Hip Replacement/Repair). Physicians are being evaluated on the total cost associated with their patients, not just the costs that are directly attributed to a specific provider for these patients.

These measures include the Medicare HCC risk adjustment program, which uses a patient’s age, sex, and ICD10 diagnosis codes included on the medical claims to determine a risk score, which is a relative measure of how costly that individual is anticipated to be compared to all other Medicare enrollees. Patients seen by a physician can differ in their expected cost, and/or risk, because of differences in their health status. The intent of risk adjustment is to allow a physician that sees a higher proportion of high-risk patients (i.e my patients are sicker) credit for higher costs, and going forward under MIPS, to be paid more for their services compared to their peers providing similar services. This is Medicare’s shift for Part B payments from volume to a focus on quality, efficiency, and value.

About 8,000 of the approximately 50,000 ICD10 diagnosis codes are utilized in the CMS HCC risk adjusting model. Only when a CMS - ICD10 code is utilized in a claim will risk adjusting happen. HCC Tools provides physicians, their staffs, and all providers billing Medicare Part B with a quick and easy way to identify this subset of the ICD10 diagnosis code system used by CMS, and appropriately include these codes in their billing to CMS.