Lunch and Learn
How do we get paid for physician services in medical practices? Watch this 10 minute video and download the handouts below for an overview of HCC diagnosis coding. Also see the billing guide and other diagnosis coding resources here.
In the past, payment has been based on what we do, the CPT code, or HCPCS code billed on the claim form. In a fee-for-service world, payors use diagnosis codes to establish the medical necessity for the service.
That changes as we move into accountable care organizations (ACOs), shared savings programs, or risk-adjusted contracts with commercial payors.
With these models, the payor is using diagnosis coding to establish how sick our entire panel of patients are. They then use that information along with utilization, quality data and patient satisfaction to change the amount we get paid, not on the individual claim, but at the end of the contract year. Either as a bonus, a penalty, or a rate adjustment.
This first of two modules gives an overview of HCCs (Hierarchical Condition Categories). The second looks at review compliance related issues.
Be sure to download the companion resources below before watching.
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The CodingIntel Guide to Hierarchical Condition Categories provides a comprehensive list of HCC and Risk Adjusted Diagnosis Coding resources available on CodingIntel.