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. For many, VBC captures why they became doctors in the first place. But for some, the documentation requirements associated with the value-based care model stand in the way.


“The documentation is intimidating,” agrees the Chief Clinical Officer of a leading at-risk physician group. “And it wasn’t something that providers learned in medical school.” The ‘intimidating documentation’ around HCC coding is highly off-putting to providers. They don’t care about it, they don’t want to learn it, and they’d rather be spending time with patients. So why does accurate HCC coding matter, and how can we make clinicians care about it?


The problem


Physician burnout remains a major issue, and it’s clear that the accumulation of non-clinical tasks is a significant contributing factor. As an example, a recent study from the American Journal of Medicine reports that primary care physicians spend an average of two hours interacting with an EMR for every hour of patient contact – that’s 4.5 hours each day in the clinic, with an additional 90 minutes at home every evening. This quote from the same report puts the problem into context:


“I am no longer a physician but the data manager, data entry clerk and steno girl… I became a doctor to take care of patients. I have become the typist.”
American Journal of Medicine


With physician burnout rates reportedly as high as 63%, it’s hardly surprising such attitudes persist. In the value-based care model, learning the intricacies of risk adjustment and maintaining accurate documentation represents another time-consuming task for clinicians. That’s why it’s so crucial that they understand and appreciate the value of accurate HCC coding.


Accurate HCC coding and reimbursement


“In addition to helping predict healthcare resource utilization, RAF scores are used to risk-adjust quality and cost metrics. By accounting for differences in patient complexity, quality and cost performance can be more appropriately measured.”
American Academy of Family Physicians


The first and most obvious point to make here is that accurate HCC coding has a direct influence on reimbursement. The risk-adjustment model depends on all risk-adjusting conditions being coded accurately – ensuring each patient has a risk score that suitably reflects their likely cost of care. Therefore, accurate coding ensures that healthcare services are appropriately reimbursed for the level of care provided to patients. In a nutshell, clinicians and other medical staff should care about accurate HCC coding because it ensures they get paid.


Inaccurate coding, meanwhile, can lead to under- or overpayment – either of which can be highly damaging to an organization’s financial stability.


Accurate HCC coding and compliance


While HCC compliance regulations can seem vague or confusing, the most common causes of audit failure include the following:

  1. Under-documented chronic conditions
  2. Incorrectly-recaptured acute codes
  3. Incorrect initial encounter codes
  4. Exclusion codes coded together
  5. Inclusion codes missed

Accurate HCC coding, therefore, is a matter of regulatory necessity if organizations are to avoid penalties and other legal repercussions. While compliance isn’t necessarily the most powerful motivator for reluctant clinicians, it is an important reminder that accurate HCC documentation is non-negotiable for VBC organizations.


Accurate HCC coding and patient care


“Accurate diagnosis coding can help your team identify high-risk patients and give them the right care at the right time.”
American Academy of Family Physicians


This final point is likely the one that will resonate most powerfully with clinicians and other clinic and hospital staff. At its heart, the value-based care system is about reducing costs and increasing the quality of patient care.


As a part of that, accurate HCC coding helps:


  • Identify patients at greater risk of certain conditions or complications
  • Implement preventative screenings and lifestyle interventions
  • Minimize hospitalizations and readmissions
  • Ensure patients have access to the appropriate resources for their needs
  • Improve patient understanding and management of chronic conditions
  • Improve care coordination
  • Ensure all relevant providers have access to accurate, up-to-date information on patients’ health status
  • Improve quality reporting and identify areas for improvement

Accurate HCC coding is an unglamorous but essential aspect of value-based reimbursement – helping to support the fundamental promise of value-based care to improve patient experiences and enhance patient outcomes.


Improving engagement, getting buy-in


“Physician engagement can make or break a hospital’s HCC-capture strategy.”


It’s clear that accurate HCC coding is vital to the success of accountable care organizations and other VBC providers. But to code accurately, clinicians and other staff must first undergo HCC coding education. The trouble is, traditional methods of HCC training no longer work. Knowledge retention rates for ‘tired and tested’ techniques such as lectures, written materials, and demonstrations range from between 5% and 30% – which is to say nothing of the critical matter of clinician engagement.



Here at DoctusTech, we employ a revolutionary app-based learning method using a mix of multiple-choice questions and clinical vignettes. This active learning approach generates knowledge retention rates as high as 75%, and better yet, clinicians love it. Our research shows that the DoctusTech app is the preferred method of HCC education for 9 out of 10 clinicians, with an engagement rate of 90%.


If you’re struggling to get your clinical staff to care about accurate HCC coding, it’s time you tried the DoctusTech app. Schedule a demo today.