In 2022, the Centers for Medicare & Medicaid Services (CMS) will begin relying on encounter data alone for Medicare Advantage (MA) diagnoses. For accurate provider reimbursement, improved capture of all possible hierarchical condition category (HCC) codes is essential.

In the past decade, MA enrollment has doubled, accounting for 39 percent of all Medicare patients. CMS currently calculates risk scores using a combination of encounter data and diagnoses submitted to the CMS Risk Adjustment Processing System. But as of 2022, CMS will rely solely on encounter data. This means that correctly capturing diagnoses during encounters — particularly with complex patients — is absolutely vital for receiving accurate reimbursement. Implementing actionable HCC alerts streamlines the process and optimizes diagnosis coding.

Download our e-book to gain insights on:

• Current challenges facing the EHR infrastructure and why HCC is so important
• Implementing HCC and how it works
• How Community Health Network implemented HCC with a positive financial impact of $11 million