This week, Terry introduces a new ICD-10-CM topic of HCC (Hierarchical Condition Category) coding relies on ICD-10-CM coding to assign risk scores to patients. Each HCC is mapped to an ICD-10-CM code.

Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurance companies can use a patient’s RAF score to predict costs for sick patients.

Terry also discusses the importance of HCC coding and why the OIG is looking at the accuracy or an FCA could be an issue.

Tune in for all of the details.

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