In the world of health and medicine, doctors and health plans have always focused on helping patients to the best of their abilities. One very important factor for ensuring excellent patient care is disease prevention and this is why the original set of International Classification of Diseases (ICD) codes was developed over 100 years ago. ICD codes were designed as a way to classify and track diseases, grouping similar symptoms and diseases for easier classification. In the United States, the codes are still used to some extent for the purpose of keeping track of diseases. However, ICD codes are mainly used for billing purposes in the United States nowadays and to make these codes more suitable for billing, the Hierarchical Condition Categories (HCC) system was developed.
Origins
ICD-9 CM codes, the current set of codes which HCC codes are derived from, was implemented in the United States in 1979. These codes consist of 3-5 numbers and 2 different alphanumeric digits. Throughout the years adaptations have been made to the ICD-9 codes in an attempt to update them and make them easier to use for billing purposes, however, the codes are still difficult to work with. The ICD-9 codes are somewhat outdated as in recent years modern medicines and technologies have evolved greatly. The codes are also not specific enough to accurately describe and diagnose certain conditions and illnesses. For these reasons, all health providers that fall under HIPAA guidelines will be transferring to ICD-10 codes on October 1, 2015. This new set of ICD codes has been designed to eliminate many of the billing and diagnosis problems that exist with the current codes.
What Are HCC Codes?
In response to the difficulties that existed with ICD-9 code billing, Medicare decided to begin using the HCC coding system in 2004. The HCC coding system is a risk adjustment model that was implemented as an adjustment to the way that Medicare and Medicaid were reimbursing private health providers for the services they were providing their patients. There are 70 different HCC categories and these categories are all based off of the ICD-9 diagnosis codes. The categories cover a wide range of health related issues and because of this, a patient may fall under multiple HCC categories.
How the System Works
In order to determine reimbursement amounts, the Centers for Medicare and Medicaid (CMS) must evaluate and update the HCC coding system every 12 months. The HCC data must be collected every 12 months for evaluation so that the CMS can pay the Medicare plans who then reimburse the health care providers. This multistep process of evaluating and reimbursing can be quite complicated and is a very delicate process. If health care providers do not document conditions and code accurately, it can delay or prevent them from earning the correct reimbursements amounts that they are entitled to. HCC codes are complex and can be confusing for healthcare providers especially since they are updated frequently to try to make them more accurate.
Are You Coding Correctly?
HCC coding must be done properly by health care providers as it is the key for them to earn their reimbursement money and keep their doors open. Many healthcare providers regularly code incorrectly and miss out on this reimbursement money that they have rightfully earned. In order to ensure that your facility is getting back all of the money that you deserve it is recommended to outsource your coding work to trained professionals. At HCC Coders we hire the best coders in the business and provide them with all the additional training they need. Our team is made up of experienced coders who regularly keep up with HCC changes and updates to ensure that we provide the highest quality service possible. Visit us today at HCCCoders.com or give us a call to learn how we can ensure more revenues for your practice.