Importance of Hierarchical Condition Category Coding

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About this program

Back by Popular Demand. Rebroadcast of a PMI favorite.

The collection and validation of patient diagnoses is organized first by diseases and conditions and then by condition categories. Hierarchical Condition Categories (HCC) play a vital role in demonstrating illness complexity, assessing the health of populations and payment for healthcare services. The importance of consistent, accurate, and complete documentation in the medical record can’t be overemphasized. Documentation and specificity are the keys to success with HCC coding. For example, chart documentation must show that the condition was monitored, evaluated, assessed, or treated. A diagnosis code may only be reported if it is explicitly spelled out in the medical record.

Improving accuracy of clinical documentation positively impacts Risk Adjustment Factor (RAF) scores and coding. This course will help your team ensure that consistent, accurate, and complete documentation processes are in place. Get clarity for HCC coding situations. For example, two sources of data determine a patient’s RAF - demographics and health status based on ICD-10-CM codes.

Learning objectives include:

Optimize Hierarchical Condition Categories (HCC) and Risk Adjustment models
Identify the entities that use HCC and Risk Adjustment for population health and reimbursement.
Review best HCC Coding best practices
Develop an internal action plan to leverage HCC Coding

Kem is the CEO of Medical Revenue Cycle Specialists (MRCS) and a national Revenue Cycle, Coding, Practice Management and Technology Optimization expert. She is the author of “Revenue Cycle Management: Don’t Get Lost in the Financial Maze” and “Advanced Strategy for Medical Practice Leaders: Financial Management Edition” as well as the co-host of, “RevDive” with Taya & Kem” podcast.

With a desire to improve healthcare workforce education, Kem is a Practice Management Institute (PMI) faculty member and serves on the Certified Medical Office Manager (CMOM) Certification Committee. She instructs the “Revenue Cycle Management 101” course under a collaboration with Howard University and the University of the District of Columbia.

Mrs. Tolliver holds dual Bachelor of Science degrees in Healthcare Administration (Summa Cum Laude) and Organizational Management (Magna Cum Laude). Her certifications include Certified Medical Office Manager (CMOM), Certified Professional Coder (CPC) and Fellow of the American College of Medical Practice Executives (FACMPE).

For over 25 years Kem has provided strategic and operational leadership to medical practices, health systems and technology innovators. Practices managed by Kem have received MGMA® “Better Performing Practice” distinctions in the areas of Accounts Receivable and Collections.

Kem’s organizational governance roles include Board of Directors - Laurel Regional Hospital, Novitas Carrier Advisory Committee, PHIT4DC Advisory Committee, Tri-State ACO Board of Directors, President of the Prince George’s Chapter - AAPC, Chair of the Government Affairs Committee – Maryland MGMA, State of Maryland ACMPE Rep and Board of Directors - Cultural Academy for Excellence (CAFE).

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About this program