HCC Coding — Medicare Advantage to the Physicians

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HCC Coding — Medicare Advantage to the Physicians

Boyd: What are you talking about when you’re talking about HCC Coding?

Alicia: HCC Coding is a type of specialty coding and it’s hierarchical coding and that’s done for Medicare Advantage. It’s only done for Medicare patients and eventually it’s going to move over. Right now reimbursement in mainstream for physician practice is based on CPT codes or the procedures that they do for you, but Medicare it’s based on your diagnoses. And it’s all about projection, so they’re projecting how much money they need to set aside for you so that they don’t run out; and the sicker you are, the more money they set aside for you. So, if you take Medicare Advantage to the physicians it behooves them to take very sick patients because they get – you know, more money is set aside for a sick patient. You want people to be healthy and everything, but if a person has hypertension, and they have Medicare; and a person has hypertension, diabetes and cholesterol, they’re going to get more money off of that person because they have to treat that person for those many diagnoses. And eventually, I suspect and there’s talk of that with the healthcare system going, the way it is, it will move to diagnosis reimbursement again versus the procedures. It was like that in the past, sometime before my time.

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