HCC capture: How to engage specialists and succeed in value-based care


    Specialists must be part of any value-based care strategy going forward to meaningfully reduce costs and improve population health. But it’s difficult to know where to start. Begin those efforts with one ‘no regrets’ strategy—engaging specialists in accurate HCC capture.

    Hierarchical Condition Categories (HCCs) are groupings of ICD-10 diagnosis codes for active and chronic conditions. Medicare and other payers use HCCs to calculate patient risk scores and predict costs, which inform provider organizations’ reimbursement and performance benchmarks. Put simply: If ICD-10 codes aren’t coded correctly and HCCs underrepresent disease burden, reimbursement will be lower and quality benchmarks will be more difficult to achieve in shared savings programs.

    And it isn’t a one-time action—diagnosis codes must be updated every 12 months. Otherwise, CMS does not count them.

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