Home Forums Discussions Coding and Billing HCC

Does anybody have a way to use Amazing Charts to help with HCC Audits and reports?
Is there a way to use the Decision Support to help you remember to code your HCC codes each year on your eligible patients?
Anyone have a way to use the diagnosis selector to choose the HCC code over the less hierarchical code?
thanks

Excuse my lack of knowledge, but what is HCC?

"The CMS hierarchical condition categories (CMS-HCC) model, implemented in 2004, adjusts Medicare capitation payments to Medicare Advantage health care plans for the health expenditure risk of their enrollees. Its intended use is to pay plans appropriately for their expected relative costs. For example, MA plans that disproportionately enroll the healthy are paid less than they would have been if they had enrolled beneficiaries with the average risk profile, while MA plans that care for the sickest patients are paid proportionately more than if they had enrolled beneficiaries with the average risk profile."
(from http://www.cms.gov/Medicare/Health-...loads/Evaluation_Risk_Adj_Model_2011.pdf).

Not a lot here for a pediatrician, Wendell.

Of course SWheaton may use HCC to mean hepatocellular carcinoma...but I doubt it.

Hello SWheaton,

From what I understand of HCCs, there needs to be an HCC code used on patients that meet certain diagnosis criteria.
Given that, there is a way to handle this in Decision support. To do this, go to Admin Options and select Set Health Maintenance and Add a new rule (example: called HCC 80 ? Heart Failure). Make sure to put in an age range and make it a level A rule, so it will show and save the rule. If you only want this to appear once in a year, set the min, max, and recommended interval for 1 year. Open the rule and go to Additional Settings, Edit Conditions. Add any ICD9 code that should turn on this rule (for this example: 428.0, 428.1, etc).
You will now see this rule come up in any patient?s Decision Support tab that has one of those diagnosis codes. You can then decide to make as complete or leave as due and then run a report on all patients who meet this criteria in the Reports section


Now I realize this may not be the answer to your question, this is just the extent of my knowledge at this time, but if you feel you could elaborate on the subject I can always resource further information regarding this.

I hope this is helpful, thank you!

Stefan Ferreira
AC MU Specialist

Thanks Stefan, that is what I am looking for.
And that is what I thought I would try to do. This can solve the problem of remembering to code for every diagnosed HCC code once per year.

Am I correct that you work for AC? Would you ever consider giving the HCC codes a different color in the select a diagnosis list? Right now the yellow codes are flagged as unnaceptably weak, the green are good enough, Could we not turn the HCC codes Red? Or Purple?

Part of the goal as a clinician is to get the most accurate diagnosis possible, and you would get more money if you can pick the HCC ones over the garden variety, even though both are correct.

Right Jon, the acronyms abound!

We handle this with a card file at the front desk which lists the patients current list of HCCs. HCCs need to be billed at least every 6 months for the insurance company to get any benefit (which they should pass on a portion to you). Putting these in the Health Maintenance section is a good idea and we may start that but that list is currently so large that we only like to touch it once a year at annual exams.

So, I entered in the 2000 or so diagnoses into the Decision Support system.
Took me a while, but I'm stubborn like that. Anyhow, it works very well to alert you to the fact that the patient has an HCC diagnosis in their problem list, and I set it to remind once per year.

HCC diagnoses for Medicare Advantage patients need to be addressed (diagnosis, status and plan) once per calendar year. So, starting the first of the year we set out to document each of the existing risk-adjusting diagnoses.

So where and how does this get reported and what benefit would there be to an outpatient only practice in the boondocks. I have a few Medicare advantage patients and I notice that they are excluded from my PQRS reporting. I have a lot of complicated multi chronic disease patients. Does this get reported on claims? I am not familiar with this.

St Lawrence: Your claims data goes to the Medicare Advantage plan and they receive a bonus from CMS based on the complexity of the patients. They should be passing that bonus back to you. There could be significant benefit to any outpatient practice depending on how well you learn how to code for the risk adjusting codes.