Suspect HCCs

The CMS Hierarchical Condition Category (HCC) risk adjustment model is quietly becoming a key component in healthcare. CMS uses it to adjust payments to Medicare Advantage plans and value-based reimbursement programs like MACRA, and it is becoming central to risk sharing arrangements between organizations.

As HCC coding is increasingly an economic and clinical imperative, the diagnostic codes that form the foundation of HCCs can remain inaccurate or incomplete, particularly for new patients. This not only reduces payments for healthcare organizations, it impacts the resources available for addressing the full spectrum of patient needs, particularly for complex patients.

ClosedLoop’s Suspect HCC models identify patients with undocumented-yet- suspected HCCs including the contributing factors that best explain why each HCC is suspected. This helps organizations produce accurate and complete documentation, identify and prioritize actionable opportunities for clinical teams, and enhance their education and management efforts.

33%

of patients with HCC conditions are not diagnosed or treated from one year to the next

26%

of practices say that accurate and complete coding is a big challenge to utilizing HCCs

70%

of practices say their biggest need is having a way to identify and prioritize patients with gaps in diagnoses

See How ClosedLoop Can Identify Potential Suspect HCCs

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