Risk Adjustment

HCC Tip Tuesday

Observing the hierarchies in HCC models will help any analytics and review efforts to focus efforts and maximize efficiency. Diabetes mellitus (with acute complications, with chronic complications, without complications) is the most commonly recognized hierarchy in most models, but be sure to take others into account, such as malignancies, liver disease, paralyses, ischemic heart disease, vascular disease, kidney disease, and head injuries. Efforts to identify support for a particular risk adjusting diagnosis are irrelevant if a hierarchically superior diagnosis has already been supported by provider documentation. Analytics should also take the potential progression of lesser conditions into more serious via the HCC hierarchies.


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Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider