HCC HEMATOLOGY ONCOLOGY SESSION
1
PROFESSIONAL REVENUE
MANAGEMENT SERVICES
HCC HEMATOLOGY ONCOLOGY SESSION
PROPRIETARY AND CONFIDENTIAL | FOR DISCUSSION PURPOSES ONLY
DELAWARE VALLEY ACO
ACCOUNTABLE CARE
ORGANIZATION
HIERARCHICAL CONDITION CATEGORY
PURPOSE
PROFESSIONAL REVENUE
MANAGEMENT SERVICES
PROPRIETARY AND CONFIDENTIAL | FOR DISCUSSION PURPOSES ONLY
2
DELAWARE VALLEY ACO
ACCOUNTABLE CARE ORGANIZATION
The Purpose of Hierarchical Condition
3
Category (HCC) Coding
? To accurately reflect the health of your patient population
o Risk adjustment scores are higher for a patient with a greater disease burden and less for the more healthy patient
o The diagnosis codes that are reported by your practice on the patient claims determine the patient's disease burden and risk score
o Chronic Conditions are reported once per year (or more based on visit pattern of the patient and the complexity of their condition)
PROFESSIONAL REVENUE
MANAGEMENT SERVICES
PROPRIETARY AND CONFIDENTIAL | FOR DISCUSSION PURPOSES ONLY
DELAWARE VALLEY ACO
ACCOUNTABLE CARE
ORGANIZATION
The Purpose of Hierarchical Condition
4
Category (HCC) Coding (continued)
? There are over 9,700 ICD-10-CM codes that map to one or more of the 86 HCC codes included in the 2021 CMS-HCC Risk Adjustment Model. Examples of Conditions represented include:
o Amputation o Chronic Kidney Disease o Chronic Obstructive Pulmonary Disease o Coagulation Defects o Congestive Heart Failure o Diabetes Mellitus o Morbid Obesity o Peripheral Vascular Disease o Others such as MI, CVA, and Fractures
PROFESSIONAL REVENUE
MANAGEMENT SERVICES
PROPRIETARY AND CONFIDENTIAL | FOR DISCUSSION PURPOSES ONLY
DELAWARE VALLEY ACO
ACCOUNTABLE CARE
ORGANIZATION
Two Patients, Same Diagnosis, Different Care 5
? Patient A is newly diagnosed with influenza and pneumonia
o Patient A is 35 o Patient has no chronic
diseases
? Patient B is newly diagnosed with influenza and pneumonia
o Patient B is 72 o Patient comorbidities: o Diabetes, type 2 o Chronic bronchitis o Emphysema
PROFESSIONAL REVENUE
MANAGEMENT SERVICES
PROPRIETARY AND CONFIDENTIAL | FOR DISCUSSION PURPOSES ONLY
DELAWARE VALLEY ACO
ACCOUNTABLE CARE
ORGANIZATION
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