HCC Capture and Documentation Consulting

Improve care delivery while making an impact to your bottom line

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Our EHR consulting engagements include:

Hierarchical Condition Category (HCC) is a risk adjustment model implemented by CMS in 2004 to estimate predicted costs for Medicare beneficiaries based on disease and demographic risk factors, leading to increased payments for high-risk patients. Inaccurate reporting of HCC chronic conditions and their associated HCC codes may lead to significant foregone care delivery and revenue opportunities.

Clinovations, a division of Advisory Board Consulting, works with provider organizations to develop HCC coding and documentation competencies and implement strategies to engage clinicians in documentation improvement.

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Current challenges and opportunities

Provider organizations are facing several challenges as they plan for HCC coding and documentation:

  • Provider engagement, education, and incentive alignment
  • Impacts to workflow and efficiency
  • Insufficient or incomplete medical record documentation in the EHR
  • EHR disconnect and poor problem list utilization
  • Incorrect coding
  • Inferior or non-existent HCC-specific analysis and prioritization

Our experts work with provider organizations to address these challenges and enable them to use HCC coding information to form a more accurate picture of their patient populations, better manage patients’ chronic conditions, and demonstrate cost-effectiveness. After implementation, providers are equipped to:

  • Comply with guidelines while accurately capturing prioritized chronic conditions
  • Code to the highest level of specificity
  • Move through their EHR documentation workflows more efficiently
  • Automate within the EHR where possible
  • Prioritize focus through enhanced reporting and decision support capabilities

How we help

Across the country, our consultants are working with health systems to improve clinician engagement, produce measurable improvements in clinical quality, increase financial performance, and ultimately develop strategies to achieve ROI from technology deployments. Our capabilities include:

Our experts

John Kontor, MD
Executive Vice President

John leads EHR implementation, optimization, and population health and value-based care operations efforts. His unique perspective comes from his IDN experience in multiple executive roles, including Chief Medical Information Officer (CMIO), VP of Medical Affairs, and Medical Director of two employed physician networks. While CMIO, he led an Epic EHR implementation in 14 hospitals and in all of the health system’s ambulatory physician practices. John practiced Internal Medicine for 14 years, focusing on ambulatory chronic disease management and inpatient critical care.

Steve Strode
Senior Vice President

Steve leads Clinovations’ ambulatory sector, bringing more than 23 years of health administration and management consulting experience to Advisory Board. His expertise is focused in the areas of practice management, outpatient strategy and operations, and system implementation and optimization.

Brad Howard, MD, MBA
Executive Medical Director

Brad’s EHR optimization expertise is focused on physician efficiency and care improvement. As a former CMIO, he has led the implementation and optimization of multiple EHR platforms in inpatient and ambulatory sites to achieve Meaningful Use and clinical transformation.

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