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3M ambulatory and hierarchical condition category (HCC) services


The challenge: Report patient diagnoses across the care continuum

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.

Can you answer the following questions with confidence?

  • Does your data currently reflect accurate HCC risk scores based on reported diagnoses for your patient population?
  • Are all chronic conditions documented in the patient’s medical record at least once per calendar year?
  • Do you capture HCC diagnoses in all care settings?

If not, it may be time to consider a comprehensive HCC solution.

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Blogs and podcasts

Explore expert insights and discoveries at the intersection of data science and health care.

  • Back to basics: HCCs 101

    More and more Health Information Management (HIM) professionals and CDI specialists are reviewing patient records for HCC diagnoses. The history, the hierarchies and the importance of HCC diagnosis capture deserves a refresher.

  • Video: HCCs help capture complete patient story

    Learn how CDI teams at Trinity Health use tools to move beyond the capture of Diagnosis Related Groups (DRGs) to the more complete patient story provided by HCCs.

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