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When clinics shut down in 2020 due to the pandemic, fewer patients, especially Medicare Advantage (MA) patients, were seen by their doctors. Hierarchical Condition Categories (HCCs) are acute and chronic conditions that CMS requires to be documented annually to ensure MA beneficiaries are receiving quality care. Additionally, HCCs have weight factors that cumulatively represent a population’s risk score. Due to the pandemic interruption in care, our population risk score was lower than what it had been earlier. Accurate risk scores correspond to payments for CMS to compensate for the cost of caring for sicker patients. At the end of August 2020, the cumulative reconfirmation rate of known chronic HCC conditions was 54% for 2020, compared to 67.7% in 2019. This gap translates to a decrease of $35M in revenue. In August HFHS had five months left in which to document HCC conditions for 2020.

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Project #51: Revenue Cycle HCC Administration Direct to Specialists Outreach



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