Many plans currently receive radically lower premiums than those to which they are entitled.
Medicare has classified about 3,000 of the 14,000 ICD-9 diagnosis codes into HCCs or categories designating chronic conditions that end up costing them more money over the long run, such as diabetes, kidney failure, old MI, etc. When patients are assigned these ICD-9 codes, Medicare sees those beneficiaries as being more severely ill than the "average" Medicare beneficiary.
Medicare managed care reimbursement from CMS depends on accurate and complete diagnostic (ICD-9) physician coding,
ICD-9 Coding consumes more time as every code for proper premium
Physicians must report the ICD-9-CM diagnosis codes to the highest level of specificity and report these codes accurately. This requires accurate and complete medical record documentation.
Medesun HCC Services
AHIMA and AAPC Certified Coders with 5 years of experience
Validate the documentation and assign the specific codes as required by CMS
3 steps of coding audits
Identify the documentation errors and educate the providers