HCC Coding Blogs | DoctusTech

Turning aggregated and filtered data into accurate HCC coding with AI

In today’s data-driven healthcare landscape, the potential for valuable insights is vast, but so is the risk of data overload. Clinicians and coding teams face the challenge of navigating massive amounts of patient data, from lab results and progress notes to specialist reports and diagnostic tests. Hidden within this sea of information are critical details …

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How to tell if your HCC coding refresher course made a difference

You’ve invested in a targeted HCC coding refresher course to improve accuracy, boost RAF scores, or support clinicians. Maybe it was a brief CME module, a full-day workshop, or an in-app coding education tool. Now what? Too often, coding retraining efforts are launched without a clear plan to evaluate impact. But in a value-based …

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HCC recapture with AI: The key to compliance in value-based care

In value-based care (VBC), accurate risk adjustment is more than just a compliance checkbox—it’s the foundation for proper reimbursement, better population health management, and meaningful patient care. But each year, many chronic conditions go undocumented, leading to missed revenue and underrepresented patient risk scores. The issue? Poor HCC recapture. Let’s explore why this happens …

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How automated chart reviews with AI improve compliance

In an era where efficiency and accuracy in medical documentation are paramount, automated chart reviews with AI are revolutionizing how healthcare professionals handle patient data. Traditional chart reviews, often time-consuming and limited in scope, are now being enhanced with AI-driven tools that streamline the process, reduce human errors, and improve compliance with medical regulations. …

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8 Pre-chart planning strategies to catch missed diagnoses

Missed diagnoses can seriously impact HCC coding accuracy, leading to gaps in patient management. However, these oversights can be prevented with proactive pre-chart planning. By setting up a structured approach before the patient visit, healthcare teams can catch diagnoses early, streamline documentation, and reduce the risk of costly redocumentation errors. Chronic conditions like diabetes …

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How to Set Up Real-Time Feedback Loops in HCC Coding

Real-time feedback loops in HCC coding can help clinicians correct mistakes instantly and learn from them. Traditional methods of improving coding accuracy often rely on retrospective audits, which may take weeks or months before clinicians receive insights. This delay can result in missed opportunities for accurate documentation and increased administrative burden. By integrating real-time …

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HCC Coding Errors

8 Common HCC Coding Errors and How to Avoid Them

When considering a patient’s chart, every detail matters. It’s not just about the diagnosis, it’s the whole picture – missing something could affect the quality of care your patient receives. By now, it’s clear to most HCPs that accurate Hierarchical Condition Category (HCC) coding goes beyond paperwork alone. Accurate coding helps to deliver quality care …

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Why does accurate HCC coding matter?

Clinicians and other medical staff find it hard to care about HCC coding. Here’s why they should. Selling clinicians on the value-based care (VBC) model should be straightforward. In theory, it promises more time with patients per encounter – with a greater focus on patient outcomes when compared with the ‘numbers game’ of fee-for-service medicine. …

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7 Strategies to improve HCC coding and risk adjustment accuracy

Healthcare is a dynamic and complex industry, constantly evolving to provide the best possible care to patients. In this ever-changing landscape, accurate Hierarchical Condition Category (HCC) coding and risk adjustment in the value-based care healthcare model play a crucial role in ensuring quality care, managing patient populations, and optimizing revenue. Here are 7 strategies to …

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Why is HCC coding important for medical practices?

‘HCC coding’ is shorthand for the Hierarchical Condition Category (HCC) coding system used to identify and classify medical conditions for the purpose of risk adjustment. This system is used to calculate a risk score for each MA enrolee, which acts as a measure of their expected healthcare costs based on their medical conditions and demographic …

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How to improve HCC documentation and reduce risk

Healthcare providers and payers use the HCC coding system to identify the seriousness and severity of a patient’s medical condition. The main purpose of coding is to ensure that a patient receives good medical care and resources. If it is not performed correctly, then there will be some potential risks associated with HCC coding. Improper, incorrect, …

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HCC Codes Most Targeted by DOJ and Strategies to Remain Compliant

Audits are no longer just for large payors, provider groups are feeling the pressure of rising compliance audits, and the playing field is complicated to negotiate. Some of this may seem unfair, but with the cost of medical fraud on the rise, the DOJ, CMS, OIG, HMS and all the other initials are not going …

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What Is HCC Coding?

Back in 2004, CMS introduced HCC coding as a tool to help estimate Medicare costs. Today, HCC coding us used across Medicare Advantage plans, the Medicare Shared Savings Program, Medicaid, and private health plans – all deploying a variation of the risk adjustment model in order to quantify the upcoming cost of care for their …

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DOJ Files New Medicare Abuse Lawsuit Against Cigna

DOJ Audits And How DoctusTech Helps The Department of Justice has filed a new lawsuit against Cigna for overcharging the federal government by purposefully inflating how sick its Medicare Advantage members are. Federal prosecutors previously declined to intervene in this whistleblower case, but have now seemed to change their minds about it. …

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DoctusTech Helps: Change Clinician Behaviour

According to the American Journal of Managed Care (AJMC), the least effective method for continuing medical education (CME) for clinicians is distributing printed materials: emails, PDFs, flyers, email blasts, and so on. Many medical professionals believe that clinician education should be concerned with encouraging continuous development rather than simply raising consciousness. What, then, are the …

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DoctusTech Helps Value Based Care

Value-Based Care is a natural movement toward the benefit of the patient with a reduction in costs by aligning all incentives in the right direction. And as providers make the shift, patients will be encouraged both by the motive behind the transition as well as the improvement in their overall health and the reduction in …

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DoctusTech Helps: Decrease Clinician Workload

In December of 2021, the Mayo Clinic published an alarming

DoctusTech Helps: Deploy HCC coding education across your organization

HCC coding accurately estimates future healthcare costs while improving patient care. But like any other tool, it’s only effective if the people who use it master it. Without comprehensive education, even the most advanced coding tools can fall short. That’s where DoctusTech comes in, providing the support and resources to help your organization implement …

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DoctusTech Helps: Increase RAF Accuracy

“I don’t care if the RAF goes up or down, I only care if it’s accurate.” Dr. Farshid Kazi, Co-Founder, DoctusTech If an organization is caught over-coding, up-coing, diagnosing conditions that either do not exist or are not supported in the chart, the cost of these errors can be very high. Audits are no …

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Amazon Announces Plans to Buy OneMedical

Amazon has announced plans to buy OneMedical for $3B. OneMedical is a brick and mortar plus digital healthcare marketplace that operates in several major U.S. markets. The acquisition is Amazon’s latest move in the healthcare sector, and analysts say it could be a sign of bigger things to come. This is not Amazon’s first foray …

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DoctusTech Helps Clinicians Learn HCC Coding

DoctusTech Helps Clinicians Learn HCC Coding

DoctusTech helps clinicians learn HCC coding through clinical vignettes in an app that is fun and engaging. Diagnosing with the appropriate HCC code is a critical skill for modern clinicians who care for patients in a value-based care arrangement. You cannot treat what you do not accurately diagnose, and you cannot afford to treat what …

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Everything You Need To Know About HCC Coding Training

Everything You Need To Know About HCC Coding Training

Why is HCC coding training important? Without proper coding, it is impossible to diagnose accurately, treat effectively, document those diagnoses, or achieve revenue goals. Coding training will help you master the skills you need to properly code patient records, so investing in HCC coding training might be the right move for you! Read on to …

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Risk Adjustment Coding

Risk Adjustment Coding – Challenges And How To Get It Right

Risk adjustment coding is a vital part of any managed care organization. It helps to ensure that patients are appropriately diagnosed and documented accurately according to risk level, which in turn allows the organization to receive appropriate capitated payments to provide all the care needed to reduce avoidable hospitalizations and achieve maximum health. And regardless …

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4 HCC Coding Education Strategies for Physicians

HCC coding education is a fast growing need for physicians. To meet the demands of today’s fast-paced and dynamic healthcare environment, many are now accelerating their transformation from a hospital-centered fee-for-service model to a more patient-centered model, and Value-Based Care is at the forefront of this change. The increased HCC coding knowledge requires clinicians to …

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4 KEY HCC Coding Challenges Clinicians Face

4 HCC Coding Challenges All Clinicians Face

As the U.S healthcare system transitions towards value-based payment models, independent clinicians and physician groups continue to face HCC coding challenges that not only impact their bottom-line, but patient care as well. On top of all this, the pandemic has added a significant burden to the already stretched clinician workload. Here are 4 key …

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HCC Coding and Physician Burnout

HCC Coding and Physician Burnout

RaDonda Vaught was just sentenced to three years of supervised probation. The former Vanderbilt University Medical Center nurse was found guilty of negligent homicide and gross neglect of an impaired adult in the death of a patient, because she administered vecuronium rather than Versed. A tired, overworked nurse could not find the prescribed medication …

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A Quick HCC Coding Knowledge Hack

Looking for a quick HCC coding knowledge hack? Use this Quick Guide to identify HCC codes for risk adjustment. Diagnosis coding for value-based payment models is one of the key drivers for innovation in modern healthcare – aligning incentives with care in ways that were only talked about in decades past. However, without appropriate and …

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Healthcare Industry Shift Toward VBC

Healthcare Industry Shift Toward VBC

It has long been thought that the machinery of the US healthcare system is so big, so complex and so established that steering the ship is nearly impossible. However, if we’ve learned anything from the COVID-19 pandemic, we can be nimble when we have to be. Lives were on the line, the nation itself was at …

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Full Risk Value-Based Care

The Market Is Moving Toward Full Risk Value-Based Care

The US healthcare market is leaning in the direction of Full Risk Value-Based Care. While the system is often characterized as a monolith; a massive, unwieldy machine (and as immovable objects go, it is a big one), that big machine is trending steadily toward full risk value-based care. The CMS recently reported that total …

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HCC Coding Education For Family Physicians – AAFP

Specificity and accuracy are the keys to any successful Value-Based Care program. And clinical vignettes are a great way to learn. Five years ago, the AAFP (American Academy of Family Physicians) published a crash course to educate family physicians on HCC coding. To this day, the clinical vignettes from this family physician HCC coding …

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HCC coding education for doctors: The easy way

Requiring clinicians to learn one more thing—especially when HCC coding does not feel connected to treating patients—is a big ask. Expecting them to learn in ways that are both ineffective and profoundly dull is just plain cruel. Doctors talk a lot about behavior change in patients. But behavior change in doctors is incredibly tricky …

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HHS secretary Xavier Bacerra on overcoding in medicare advantage

HHS Secretary Becerra Addresses Upcoding in Medicare Advantage

In Friday’s “State of the Department” address, HHS Secretary Xavier Becerra spoke candidly about upcoding and overcharging in Medicare Advantage. After offering prepared remarks on the continuing COVID public health emergency, Robert King of Fierce Healthcare asked very pointedly about upcoding in Medicare Advantage. Secretary Becerra answered with few specifics, but a clear directive that …

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ACO REACH DCE CMS

ACO REACH Model Replaces GDCP (DCE) Model – But What Really Changed?

CMS recently unveiled their replacement for the Direct Contracting Model (DCE), renamed now as the ACO REACH Model. Many of the original Direct Contracting Model tenets will remain the same, with a few significant changes announced. From heightened scrutiny on up-coding and documentation accuracy to improved Access and Equity, the new model looks to improve upon …

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VBC Strategies for 2022: What to STOP, START and CONTINUE?

Levi Wiggins: Alright. Here we are. Live with Dr. Kazi for Year End Preparation for 2022: things to stop doing, things to start doing and things to keep doing. Our host, as always, is Dr. Kazi. Give us a brief introduction! Farshid Kazi, MD: Thank you everybody. Farshid Kazi, internist by training, with …

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ACOs Risk adjustment coding in medicare shared savings program HCC MSSP

How the MSSP Rule Reshapes Risk Adjustment Coding for ACOs

Quick glossary CMS = Centers for Medicare & Medicaid Services MSSP = Medicare Shared Savings Program ACO = Accountable Care Organization HCC = Hierarchical Condition Categories RAF = Risk Adjustment Factor CMS released its final Medicare Shared Savings Program rule, called Pathways to Success, for ACOs. The new rule is designed to help establish …

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Diagnosis Coding For Risk Adjustment – Are You Ready (AAFP)

The AAFP is a great first-stop for information on Risk Adjustment and HCC Diagnosis Coding. Although this article is a few years old (2018), its take on HCC Diagnosis Coding for Risk Adjustment is both unique and extremely helpful. First, they lay out what it is and how it works. Then they tie it in …

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HCC Coding Program

5 Strategies for a Highly Effective HCC Coding Program

You need a highly effective HCC Coding Program. If you’re a physician group engaging in value-based care arrangements: coding and documentation accuracy should be your top priorities, and failure to act can lead to lost revenue and significant audit penalties. And inaction on your part will result in immediate loss of revenue and exposure to …

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What is HCC Coding: Risk Adjustment Models in Value-Based Care

As healthcare continues shifting from fee-for-service (FFS) to value-based care (VBC), accurate documentation and coding have become more critical than ever. Hierarchical Condition Category (HCC) coding is at the heart of this transition. In this article, we’ll explore the fundamentals of HCC coding, how it impacts reimbursement, and why providers—even those outside of VBC—should …

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