Helping Your Organization Receive the Maximum Reimbursement to Care for Your Medicare Advantage Population

It is critical for providers to accurately capture Hierarchical Condition Categories (HCC) on an annual basis that reflects the health status of the patient to maximize revenue. Optimizing HCC helps the practice, payers, and patients.

Due to the complexities of Medicare Advantage and value-based care, many healthcare organizations need assistance navigating HCC documentation and guidelines. CTG's experienced, dedicated team can help you overcome common challenges, such as: 

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    Lack of Provider Training

      • High Usage of Non-Specific Codes: Improving HCC coding at point of care 
      • Inadequate Documentation: Ensuring documentation supports the level of HCC code and patient conditions 
      • Anxiety Over Alerts: Lack of knowledge and usage of BPA/CDS alerts
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    Inefficient Provider Panel Management

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    Cumbersome Patient Allocation

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    Ineffective Problem List Management

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    Insufficient Monitoring or Availability of HCC Data

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    Lack of Outreach for HCC Recapture

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    HCC Software Not Optimized

What is HCC?

Hierarchical condition categories—HCCs—are 86 sets of medical codes linked to specific clinical diagnoses.

HCC coding is used to assign patients a risk adjustment factor (RAF) score. Healthier patients have a lower score while less-healthy patients have a higher score. RAF scores help scale payments to reflect a patient’s risk (i.e., higher risk = higher future costs = higher payments).

The Centers for Medicare and Medicaid Services uses HCC to identify Medicare Advantage patients with serious acute/chronic conditions to estimate future healthcare costs.

hcc implementation offerings

Medicare Advantage and managing risk is not just about HCC codes. We meet you where you are by assisting the practice with a well-rounded solution and strategy to maximize reimbursement and expand care for high-risk patients.

CTG provides the following support during a typical HCC activation/optimization project:

  • Health ID Record

    Update Diagnosis Content

  • Software

    Activate or Optimize HCC Software

  • Review Assess Checklist

    Requirements for Regulatory Compliance

  • Requirements Regulatory Compliance

    Develop Processes to Manage Problem Lists

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    Implement Management Strategy and Build of Registries

  • Analytics

    Develop Metrics for Reporting, Dashboards, and PDSA Cycles

  • Business Solutions

    Advance HCC Roles and Workflow

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    Ensure Documentation Supports HCC Coding

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    Change Management

CTG also offers the following support services, if requested:

  • Training Education

    Provider and Staff Education

  • Health Scheduling Appointment

    Medicare Annual Wellness Management

training offerings

CTG has extensive experience with the following training options and can customize based on a client’s needs:

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    Instructor-Led Videoconference

  • Video Webinar

    Self-Directed E-Learning Modules or Practice Exercises

  • Computer/Webinar

    E-learning, Webinars, Instructor-Led Content

  • 3 People

    In-Person, Hybrid, or Virtual Training

CTG Blog

CTG's Jeanette Ball explains how close adherence to the HCC model provides three key advantages: better funding, improved patient services, and optimized care costs. Check out the blog to learn more. 

read now

Why CTG?

CTG leverages our collective expertise to deliver a successful and sustainable strategy for improving health outcomes and CMS Star Ratings.

We combine an EHR/solutions perspective, a workflow clinical perspective, and Medicare population health and supporting technologies to help you deliver optimized care. 

Let’s discuss

How CTG can help you achieve your desired business outcomes through digital transformation.

Send us a short message by completing the contact form and we’ll respond as soon as possible, or call us directly.

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