What is RAF and HCC Coding?
Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. Along with demographic factors (such as age and gender), insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score.
The HCC/RAF (Risk Adjustment Factor) point system is a “shadow” calculation that affects every physician’s reimbursement, no matter what goes on the bill. The HCC/RAF regulation assigns a point value to a relatively small number of ICD diagnosis codes that indicate serious disease.
Why Should Providers Care about RAF’s?
- Helps to identify patients who may achieve better outcomes through individualized support services such as Care Management.
- Ensures that your patients receive the appropriate level of care while supporting your efforts to coordinate their care.
- Risk Adjustment supports your practice in meeting the reporting requirements of ICD-10-CM codes, including records accuracy and timely reporting of claims and encounter data.
- Effective risk adjustment coding helps to streamline your claims process, which may result in faster reimbursement.
MEAT the best practice model for documentation.
Monitor: signs, symptoms, disease progression, disease regression, etc.
Evaluate: test results, medication effectiveness, and response to treatment
Assess/Address: ordering tests, discussion, review records, counseling
Treat: medications, therapies, other modalities
Key Things to do to Improve HCC Coding:
- Having an accurate problem list-Remove any duplicated info from EMR and identify and implement a diagnosis preference list to include HCC suffix codes and RAF values as well as prioritize results.
- Ensuring patients are seen in each calendar year- Frontload visits from patients who have not been seen in the calendar year yet to make sure they are being seen.
- Tracking performance and identifying opportunities-Reviewing unresolved persistent conditions for specific populations.