When I talk to medical practices about hierarchical condition category (HCC) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends!
Let’s separate fact from fiction.
Urban legend #1: CPT fee-for-service coding will be a distant memory when we switch from volume to value
Not anytime soon. Medicare’s newer payment models starting with Medicare Shared Savings Programs (MSSP) and Accountable Care Organizations (ACOs) are built on top of fee-for-service coding. One of the key metrics of success in the ACO model, and in the older MSSP model is the cost benchmark. Did the ACO spend more or less than the benchmark in caring for the patients attributed to it? And cost is measured based on — you guessed it — fee-for-service claims submitted for the attributed beneficiaries during the contract year.
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