We provide world class consulting services to implement HCC Coding Tools in your organization. Our resources have in-depth knowledge of various dimensions of American Healthcare with top three being Value, Cost and Risk.
We can help you retrieve and utilize the critical information hidden in various data source format files.
We can host your entire data in an entirely US based Cloud infrastructure and make it accessible to you in a Fast, Secured and Consistent fashion.
We offer both Domain and Technology level consulting at a very reasonable price for all your Healthcare IT projects. Our experience in healthcare is vast and reputed among small to very large Health systems across the country.
We strive to incorporate cutting edge technology in all of our products. Everything we build is to solve your data problems, while respecting your needs for data security and system responsiveness.
Our latest product "HCC Coding Tools" code name "Adira" has been built with the latest technologies.
Please contact us for any specific questions on our services or products. We will get back to you within an hour. We are dedicating this FAQ to our product "HCC Coding Tools"..
Medicare’s MACRA and MIPS program has added resource use measures to every physician/provider of health care services in the United States that bill the Medicare Part B program. Resource use measures are part of the MIPS scorecard that will adjust (+ or -) future year Medicare fees paid to you and your practice. Resource Use Measures include Total Per Capita Cost, Medicare Spending Per Beneficiary, and CMS is testing new Episode of Care measures, most of which are explicit to patients with specific conditions (for example, Ischemic Stroke or Osteoporosis) and specific services (for example; Coronary Artery Bypass Graft, Pacemaker, Hip Replacement/Repair). Underlying these measures is a risk adjusting system called CMS-HCC (Hierarchical Condition Category). CMS-HCC’s are the only way to account for “my patients are sicker” in your MIPS scorecard.
HCC Tools provides an easy to use system to quickly find the appropriate and relevant ICD10’s within the CMS-HCC system. There are three ways to use this tools as listed below. For a demonstration, look at our How to Videos posted at www.adiratechnology.com.
CMS has used risk adjusting programs for over twenty years in their Medicare Advantage Program (and the predecessor Medicare Part C program) and the Medicare ACO programs. The principle is that while Medicare insurers millions of patients, some of which are “sicker” than others, across a large population there are likely as many less-sick as there are more-sick patients. Once the Medicare population is split into smaller segments for health plans and ACO’s with a few thousand patients, there needs to be a way to account for differences in patient acuity.
CMS-HCC (Hierarchical Condition Categories) utilizes a subset of ICD10 diagnosis codes (approximately 8,000 of the 70,000 ICD10 diagnosis codes) to identify patients falling into one of 79 CMS-HCC risk categories. The risk categories in most cases are additive, where patients can have multiple risk factors tied to different categories and the patient risk score is the sum of the risk weights of each relevant HCC risk category in addition to relevant demographic factors. Physicians and other providers need to know how to find and use the appropriate ICD10 diagnosis codes within the CMS-HCC system to be sure they are getting credit for their patients’ illnesses. Proper coding on bills to Medicare at each patient encounter is vital, as is coding all relevant CMS-HCC diagnosis codes during a CMS annual wellness visit (billing service codes G0438, G0439). CMS-HCC does not remember patient conditions and codes from year to year. Each year all relevant CMS-HCC ICD10 diagnosis codes need to be reported to CMS through bills sent to Medicare.
Paul M. Katz
Founder and C.E.O