3M ambulatory and hierarchical condition category (HCC) services

Organizations capture hierarchical condition category services (HCCs) by documenting and coding a patient’s diagnoses across all care settings for an entire year. HCC methodology groups each chronic disease or injury into a category that predicts future care needs and determines each patient’s risk adjustment factor (RAF) score. Payers use demographic information as well as diagnoses from inpatient, outpatient and physician practice encounters to calculate risk scores.

Your organization’s success with risk adjustment depends on your ability to ensure accurate and complete documentation and coding. HCCs can be complex to capture, but accurate and compliant documentation has many benefits when it comes to appropriate risk-adjustment calculation.