In ongoing efforts to foster the growth and sustainment of rural collaborative healthcare systems across the
state, the Flex Program supports North Dakota CAH staff access to financial and operational improvement
education. The following educational webinar playback is offered as part of these ongoing efforts.
Operationalizing Hierarchical Condition Categories (HCC Scoring)
- With increased movement to value based reimbursement across the
market, the ability to accurately report patients' complex needs to account for their resource and cost
utilization is becoming increasingly important. Multiple Medicare programs utilize Hierarchical
Condition Category coding (HCC) as a means of communication of a patient's diagnosis history, current
health status, and projected resource utilization. A lack of understanding of HCC and how their
resulting Risk Adjusted Factor (RAF) scores are used to provide reimbursement to organizations, leaves
you at risk of causing an unintentional negative impact to your organization's financial health.
Coding, Corroboration, and Compliance: How to Assure the "3 C's" are Met
- Regulations abound throughout every healthcare setting. Periodic
coding and medical record reviews help ensure organizations are in compliance with ICD-10 and CPT coding
guidelines, the Federal Conditions of Participation, as well as Medicare and third party payer
regulations. Without accurate documentation and coding, the organization may be at risk for reporting
errors, or may be leaving money on the table for which they are entitled.