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CMS-HCC (Hierarchical Condition Category) Risk Adjustment Audits
In January, 2000, CMS announced they would be initiating an 8-year
phase-in of a risk adjustment payment method for their Medicare Advantage
(formerly Medicare + Choice) enrollees. The program is based on a
set of Hierarchical Condition Categories (HCC) designed to pay the
health plans an adjusted payment to account for care for the plan's
sickest beneficiaries. CMS has published a complete list of the ICD-9
CM codes that make up the Hierarchical Condition Categories which
must be documented in the patient's record on an annual basis by the
physicians in order to qualify for the increased reimbursement. The
increased reimbursement rates will be phased in as follows: 30% in
2004, 50% in 2005, 75% in 2006, and 100% in 2007. As a result of the
phased in approach, it is important your organization get started
immediately as there may be significant dollars at stake.
The Coding Source, LLC can assist you and your organization to conduct
the necessary audits of your records to verify the physician have
appropriately documented and coded the ICD-9 CM codes for these particular
enrollees. Please contact us today to learn more about the services
we provide and how we can assure you do not miss the many deadlines
associated with this program.
Please contact Greg Sinaiko at greg@thecodingsource.com today.
There is also a significant shortage of certified medical coders. If you are having trouble hiring or retaining qualified coders, The Coding Source can help through our portfolio of services. Click on the link of interest below.
We can:
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