Risk Coding

Hierarchical Condition Category (HCC) diagnoses are used by Medicare to define a patient’s health status or disease burden. All applicable HCC diagnoses must be used—billed—once per calendar year as a Visit Diagnosis during an office visit in order for them to count toward a patient’s health status in the eyes of Medicare. Many of our patients have HCC gaps. These are gaps in what the current Risk Adjustment Factor (RAF) score and what it ‘could’ be based on past billed diagnoses from prior years. More accurate health status information about our population will enable us to better identify the needs of our patients and our needs in caring for them. Improved appropriate representation of our patients’ complexity will allow for more reimbursement to flow to our organization and will help to sustain and potentially expand population management programs, and other resources that support the care of our patients.

The following are for specialty specific trainings that are available to introduce this topic to specialists, now that primary care has been working on closing HCC gaps for some time.

Please click on the below link to access the appropriate training.

If you are having trouble accessing these trainings, please email BrighamCareRedesign@partners.org.

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