Coding, Classification & Reimbursement

HCC learning resources

  • 1.  HCC learning resources

    Posted 02-05-2018 13:48
    ​Hello,

    Does anyone have any recommendations on materials or resources you utilized to better understand HCCs (Hierarchical Condition Categories)? Any information would be greatly appreciated.

    I know there are some courses or webinar style materials available but some of these are cost prohibitive.

    Thank you,

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    Joshua Barrett
    Duke University Health System
    Information Governance Practice Council Member
    BSN, BS, RN
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  • 2.  RE: HCC learning resources

    Posted 02-05-2018 15:27
    Edited by Kristen Piccirillo 02-05-2018 15:29
      |   view attached
    I know you are looking for resources that are relatively low cost or free, but a couple of weeks ago I received an AHIMA newsletter with information regarding HCC and risk adjustment coding training and educational courses being offered.  I am trying to see if the newsletter was posted on Engage in one of the communities as I have since deleted it from my email.  I did find information on AHIMA's website for Risk Adjustment HCC Coder Auditor Training, which I believe may be the course the newsletter was talking about.

    The course is actually offered in coordination with Medical Audit Resource Services Inc. (MARSI) and you register directly through their website.  I have attached the course outline that is posted on the MARSI website.  The course is a bit pricey ($1995) but I know many employers offer Continuing Education reimbursement or tuition reimbursement if a course is deemed necessary for the employee in terms of their job responsibilities and professional development.  Some employers see it as a good investment to ensure their employees are brushing up their skills and acquiring new knowledge and skill sets for increased job performance.

    HCC and risk adjustment coding has been a hot topic for the last 2 years and I have seen interest for educational resources grow over time as Medicare Advantage Plans now require Risk Adjustment Factor (RAF) scores for reimbursement.  CMS is also planing to tweak the risk adjustment model in 2019 to account for mental health, substance abuse disorder, and chronic kidney disease conditions.

    I have also been reading many articles as of late outlining increases in risk adjustment fraud and coding creep.  HCC coding seems to have greater potential for Medicare fraud and abuse, which was the subject of a lawsuit brought against the largest Medicare Advantage insurer, UnitedHealth, for gaming the system and inflating risk adjustment scores.  Sometimes health plans will make patients appear sicker and higher risk than they really are, and there is a lot of pressure placed on HCC coders to bring in added revenue.  I am glad that AHIMA is beginning to offer training and courses for HCC and risk adjustment to ensure that coding professionals adhere to coding guidelines and principles and to mitigate legal and ethical concerns from Medicare fraud and abuse.

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    Kristen Piccirillo, RHIA, CCS, NASM-CPT
    AHIMA - Independent Contractor
    Engage Advisory Committee
    Engage Community Facilitator
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  • 3.  RE: HCC learning resources

    Posted 02-07-2018 02:14
    I agree with your assessment with your assessment that the HCC has the potential for Fraud and Abuse. I have worked in a facility using HCC reimbursement system for the last 29 years and also have worked in a facility using DRG based reimbursement for 22 years.... with the current EMR, pressure for providers to see more patients and pressure these providers to documentation and timely submission of documents, copying and posting of EMR is the only way providers can keep up with documentation..... resulting in so much confusion as resolved conditions are being listed as Active and Current .... a coder who follows the coding guidelines will not complete a single chart in 8 hours as each chart will require a query........

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    Josefino Lim
    CODER II
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  • 4.  RE: HCC learning resources

    Posted 02-07-2018 09:53
    Josefino,

    This reminds me of a phrase I heard during a webinar I attended not too long ago about the change from paper to electronic records.

    "With paper records, if it wasn't documented, it didn't happen. With electronic records, if it didn't happen, don't document it." 

    As you stated, the EMR has led to over documentation.  Providers are still misusing copy/paste which increases the size of the record and creates duplicative and redundant data leading to quality documentation issues.  This makes it harder for coders to abstract codes from charts, especially inpatient records, because of chart length and data accuracy and integrity issues.  HCC and risk adjustment at times can be subjective and it is important that coders are able to decipher the medical record to prevent fraud and abuse.

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    Kristen Piccirillo, RHIA, CCS, NASM-CPT
    AHIMA - Independent Contractor
    Engage Advisory Committee
    Engage Community Facilitator
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  • 5.  RE: HCC learning resources

    Posted 02-28-2018 13:01
    Risk adjustment has been a hot topic to those of us who work in it since 1997, when it was enacted and the first data sent to CMS.

    Substance abuse, mental health and kidney disease are far from new to the model--they've been included since inception.  They are being expanded, or in the case of CKD, one level of CKD is being added BACK into the model.

    Hospital data has been risk adjusted since 2000, physician data since 2007, so there is nothing new.  Health plans have been paid this way for a very long time, and all of them (ours included) have expended a great deal of time and resources in education.

    I suggest you review the past few years Advance Notices and Announcements from the CMS website: Announcements and Documents - Centers for Medicare & Medicaid Services
    Cms remove preview
    Announcements and Documents - Centers for Medicare & Medicaid Services
    These documents comprise the Medicare Advantage (MA), and Medicare+Choice (M+C) advance notices of methodological changes; announcements issued with MA or M+C rates; and special reports.
    View this on Cms >

    No matter what you may hear, there is nothing "different" about coding for risk adjustment.  Diagnosis coding must follow Official Guidelines. Things like "MEAT" and "TAMPER" are catchy little mnemonics, but are not and never have been official.  The ONLY official information is from CMS, and the Official Guidelines for Coding and Reporting.  We've had a website (HCCUniversity.com) devoted to spreading this message for over 10 years.

    If you follow official guidelines, and train physicians to do the same, and code accurately, your patient's risk scores will be accurate.

    Risk adjustment itself is complicated.  The coder's role is like the coders role anywhere else. Do your coding ethically, completely and correctly and everything is fine.

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    Jeannette Hernandez
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  • 6.  RE: HCC learning resources

    Posted 02-06-2018 08:21
    Hello Joshua,
    HCCs are getting much more prominent with outpatient and inpatient.  Some of the resources that I have seen and used with our staff include Rose Dunn's HCCs for HIMers (this may still be available on AHIMA); The Coders Playbook for Success with Rsk Adjustment Payment Methodologies by Angela Carmichael and RCM presented a webinar in November aimed at the inpatient side of HCC.  CMS also has some good information regarding HCC and there are some informative presentations on the web from various payers and managed care groups that I have found to be very helpful.  Rose Dunn's presentation is more geared toward the coding and what to look for in the documentation while Angela's is focused on risk and payment -both are very well done.
    Good luck!!

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    Cheryl Bowling
    Client Compliance Partner
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  • 7.  RE: HCC learning resources

    Posted 02-07-2018 02:13
      |   view attached
    Hi Joshua,

    This is a very good resource that I and my colleagues have used. It is a good introduction HCC and their role in  VBP

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    Bodhisattya Roy
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  • 8.  RE: HCC learning resources

    Posted 02-07-2018 08:20
    Thank you all for the informative posts and resources. This sort of information was what I was looking for.

    Thanks again! 


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    Joshua Barrett
    Duke University Health System
    Information Governance Practice Council Member
    BSN, BS, RN
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  • 9.  RE: HCC learning resources

    Posted 02-07-2018 09:41
    Joshua,

    Below is a link for another company that is selling HCC resources that I have come across here recently.  Looks like they are fairly low cost and reviews are pretty good.  I haven't purchased these myself but in viewing the pictures they seem like they could be helpful.

    ERM Online Store
    ERM Online Store remove preview
    ERM Online Store
    Arm Your Team For Combat This Risk Adjustment Season!
    View this on ERM Online Store >


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    Mellissa Heimer, RHIT,CCS
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  • 10.  RE: HCC learning resources

    Posted 02-07-2018 10:07
    https://www.ionhealthcare.com/ is a tremendous resource.




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    Greg Zobel
    RHIA, CCA, CRC, CHPS, RT(CT)
    2018 Engage Community Chairperson
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  • 11.  RE: HCC learning resources

    Posted 02-22-2018 10:02
    ​Has anyone taken the AHIMA approved Risk Adjustment/HCC/Coder/Auditor Course through MARSI?  I have reached out to MARSI with a few questions and have not received a response.  If you have taken or are currently taking this course, I would like to chat with you.

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    Jana Stafford, CCS
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  • 12.  RE: HCC learning resources

    Posted 02-22-2018 13:37
    Jana,

    Private message me your contact information and your list of questions that you have about the program.  I have a contact at AHIMA who may be able to answer some questions if MARSI doesn't get back to you.  MARSI would probably know more specific details about the program, so maybe wait a couple of more days.  Did you try calling them at the number listed on their webpage?

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    Kristen Piccirillo, RHIA, CCS, NASM-CPT
    AHIMA - Independent Contractor
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  • 13.  RE: HCC learning resources

    Posted 14 days ago
    I can't get any info out of Marsi either, several emails and nothing. Pretty sure I will not be investing $2000 dollars in a company that cant even handle email questions. go with another company, there are so many out there like doug palmer at compliant coding systems. he has great references and for $800 that includes your test fee.

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    Allison Wallace
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  • 14.  RE: HCC learning resources

    Posted 14 days ago
    Use your brain, not your pocketbook.





  • 15.  RE: HCC learning resources

    Posted 12 days ago
    Check out HCC University

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    Christina Donahue-Taylor
    RHIA, CCS
    Section Head-Coding
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  • 16.  RE: HCC learning resources

    Posted 11 days ago
    The AMA recently released a book called Risk Adjustment Documentation & Coding by Sheri Poe Bernard and although I haven't read it yet, it looks like an excellent resource.  It was not as pricy as some of the resources and courses I've seen.  https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2850008&navAction=push

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    Kristi Pollard, RHIT, CCS, CPC, CIRCC
    Senior Coding Consultant and AHIMA-Approved ICD-10-CM/PCS Trainer
    Haugen Consulting Group
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  • 17.  RE: HCC learning resources

    Posted 9 days ago
    The book titled Risk Adjustment Documentation and Coding recently published by the AMA is an excellent resource on HCCs.   I have read through most of the book and it provides the compliance piece that is needed when educating physicians and staff on HCCs.   I also found CMS' guidance on Risk Adjustment Data Validation (RADV) Medical Record checklist which provides guidance on the information that must be
    included in the medical record that is provided to the Medicare Advantage provider.   Google "Risk Adjustment Data Validation".

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    Mary Meysenburg, MPA, RHIA, CCS

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