5 Reasons Why Hierarchical Condition Category Coding Matters

You’ve probably heard of the hierarchical condition category model (HCC) and wondered if it is worth implementing for your practice. Well, there are several reasons why it matters. Here are six of the most important reasons for using HCC coding. These reasons are critical for the success of your organization. So keep reading to learn more! Here are 5 Reasons Why Hierarchical Condition Category Coding — Foreseemed Matters.

189 condition categories

Hierarchical condition category coding (HCC) is a systematic way to classify clinical diagnoses and their costs. It uses a risk-adjustment model to identify individuals with common, severe diseases and stratify them into different cost categories. The system began in 2004 and is now being used more widely as healthcare moves toward value-based payment models. The CMS-HCC model utilizes 189 condition categories, each of which has a specific value for Medicare.

The American Academy of Family Physicians recommends HCC coding because it helps communicate the complexity of a patient and paints a complete picture. HCC coding also helps to track cost, quality, and performance metrics. In addition, governments and payers use it to measure quality and efficiency. Finally, the CMS-HCC method has the added benefit of capturing more comorbidities than Charlson and Elixhauser.

Risk Adjustment Factor score

HCC, or hierarchical condition category coding, is a method for categorizing a patient’s long-term health and complexity. By using RAF scores, providers can better account for individual patient complexity and risk differences by creating accurate cost and quality performance metrics. This course covers how to use RAF scores to determine the cost-effectiveness of different approaches to health care.

Using risk adjustment factor (RAF) scores in hierarchical condition category coding can have significant financial consequences, especially for Medicare Advantage patients. The RAF scores are calculated by combining each risk factor and multiplying it by the average Medicare Advantage patient rate (usually between $750 and $880). Once this equation is calculated, the total amount of payment that the patient will receive will be revealed. A simple example would be a 68-year-old male patient who has multiple conditions. If HCC coding was appropriately done, this patient could receive substantial reimbursement.

Recommended by AAFP 

HCC coding for chronic conditions is recommended by the American Academy of Family Physicians (AAFP) because it helps providers and payers understand the complexity of patients and paint a comprehensive picture. HCC coding can also help measure the quality, efficiency, and cost of care provided to a patient. Risk adjustment is a mechanism insurers and governments use to maximize cost-effective care for patients.

The HCC code set is an acronym for Hierarchical Condition Categories. This system groups similar clinical diagnoses into 189 condition categories. These categories are then arranged hierarchically based on their severity. In addition, specific diagnoses are excluded from the hierarchy if they are medically insignificant, transitory, or do not significantly impact healthcare costs. This leaves a final count of seventy categories used to risk-adjust Medicare payments.

Assigning codes for severe  acute conditions

A risk-adjustment prediction model, Hierarchical Condition Category (HCC) … Read More...

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Do vitamin D supplements reduce cancer, cardiovascular risk?

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A new study searches for links between vitamin D supplements, cancer, and heart disease. Raymond Forbes LLC/Stocksy
  • Initial research has suggested that vitamin D may reduce the risk of developing cardiovascular disease and cancer.
  • However, there have been few large, higher-quality randomized controlled trials (RCTs) to corroborate this.
  • A recent RCT examined the effects of vitamin D supplementation in Finland.
  • It found no association between vitamin D supplementation and reduced risk of cardiovascular disease or cancer.

Vitamin D helps the body absorb calcium, which improves bone strength. Among other roles, it also contributes to the functioning of muscles, nerves, and the immune system.

Many scientists have set out to understand how vitamin D deficiency and supplementation may influence disease. According to the World Health Organization (WHO), there is some evidence that vitamin D may help protect against respiratory tract infections, for example.

Over the past 2 years, researchers have also explored whether vitamin D reduces the risks associated with COVID-19. Although investigations are ongoing, there seems to be some evidence that these supplements might improve intensive care unit admission rates.

Two other areas of particular interest are vitamin D’s potential effects on cardiovascular disease and cancer risk. However, few RCTs have looked into this. These types of studies are the gold standard for identifying causal relationships in scientific research.

A recent study, which appears in The American Journal of Clinical Nutrition, goes some way toward addressing this knowledge gap.

Speaking with Medical News Today, Vimal Karani, a professor of nutrigenetics and nutrigenomics at the University of Reading, in the United Kingdom, confirmed that there has been a gap between the initial research and findings from clinical trials.

Prof. Karani was not involved in the recent study but has worked with some of its authors.

He explained that past large epidemiological studies “have established a link between vitamin D deficiency and the risk of [cardiovascular disease] traits in various ethnic groups.” This, he said, suggests that vitamin D supplements might lower cardiovascular risk.

“However,” he continued, “clinical trials have not provided convincing evidence of the blood pressure-lowering effect of vitamin D supplementation.”

Prof. Karani said that there could be a wide range of reasons for this, including “differences in the sample size, duration of supplementation, dose of the supplementation, age of the participants, geographical location, sun exposure, and the outcome measures. Further research is required to replicate the findings in multiple ethnic groups.”

To provide further evidence of the relationship between vitamin D, cardiovascular disease, and cancer, the researchers behind the present study conducted the Finnish Vitamin D Trial.

This took place between 2012 and 2018, and it was double-blind, randomized, and placebo-controlled.

“When we started to plan the trial, there was a lot of evidence from observational studies that vitamin D deficiency would be associated with nearly all major chronic diseases, such as [cardiovascular disease], cancer, type 2 diabetes, and also mortality,” said Dr. Jyrki Virtanen in an interview with Medical

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Utility says no health risk from chemical in water

Credit: (NJ Spotlight News)
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Middlesex Water Co. insisted that its supply to some 29,000 residents is safe and that there’s no reason for it to provide alternative sources like bottled water even though water from part of its system contains a toxic “forever chemical” at above a new state health limit for drinking water.

At a public meeting Monday night, the utility’s president, Dennis Doll, defended his decision not to pay for bottled water, install filters, or pump from other sources, saying there’s no threat to public health despite the company’s recent discovery that the presence of a chemical known as PFOA exceeds a maximum contaminant limit implemented last year by the Department of Environmental Protection.

“If this were truly a health emergency, an acute threat that posed an immediate health risk, we would pay for filters, we would pay for bottled water, we would do what it takes to keep our customers safe,” Doll said. “But at the levels we’re talking about, we do not believe this is an immediate health risk.”

Confusion over whether the water is safe to drink prompted the mayors of Woodbridge, Metuchen, South Plainfield and Edison to hire a consultant to advise them on how to proceed. Woodbridge Mayor John McCormac said the town leaders want to make sure they understand what both the DEP and Middlesex Water are saying.

“We’re not going to get in the middle of it but our residents are going to ask us questions and we want to be able to answer them with the answer from our expert,” McCormac said in an interview with NJ Spotlight News.

McCormac said the towns decided to hire a consultant for that outside perspective, not because they didn’t trust either the company or the DEP.

“They are coming at it from two different angles,” McCormac said. “One’s a private company, the other is a government. We just want to be able to tell our residents that we understand the issues, and the only way that can happen is if we have our own person explaining the issues to us.”

The consultant will help determine if residents need to buy bottled water or install filtration systems, McCormac said. “I just want them to have the facts.”

Notice sent last week

On Friday, the company issued a required “notice of exceedance” to residents of six towns in Middlesex and Union counties — South Plainfield, Edison, Metuchen, Woodbridge, Clark and Rahway.

The letter advised that test results in September showed water from a South Plainfield treatment plant contained the chemical at levels above the state’s new limit of 14 parts per trillion — which DEP has determined is the safe limit for human consumption over a lifetime.

The notice drew dozens of people to a meeting at Colonia High School where many said they were fearful of the health consequences of drinking water that contains the chemical outside a regulatory limit, and were struggling to reconcile the company’s assurances that the water is

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IBD may disrupt gut-brain axis, raising risk of anxiety, depression

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New research in mice suggests that a broken link between the gut and the brain may explain the effect of IBD on mental health. RapidEye/Getty Images
  • Around 30% of patients with inflammatory bowel disease (IBD) experience depression, anxiety, or both.
  • A new study in mice suggests that impaired communication between the gut and the brain may be partly responsible.
  • The study found that a gateway between the bloodstream and cerebrospinal fluid may close to protect the brain from inflammation during flare-ups.
  • This may disrupt the gut-brain axis, a communication channel between the gut and brain with possible links to mental health.

IBD involves chronic inflammation of the gut.

There are two main types: Crohn’s disease, which can affect any part of the gastrointestinal tract, and ulcerative colitis, which only affects the large intestine and rectum.

In 2015, an estimated 3.1 million adults in the United States, or 1.3% of the adult population, had received an IBD diagnosis.

Symptoms of IBD include persistent diarrhea, abdominal pain, weight loss, and fatigue.

According to one study, around 30% of individuals with IBD also experience depression, anxiety, or both.

The pain and discomfort that some people experience with certain chronic illnesses increase their risk of developing mental health illnesses. However, that does not appear to be the whole story in IBD.

“While the overall impact of the disease on overall quality of life no doubt plays an important role in triggering anxiety and depression in IBD, there is also increasing evidence of direct biological connections between IBD-associated inflammation and neuropsychiatric diseases,” said Dr. Gerard Honig, director of research innovation at the Crohn’s & Colitis Foundation in New York, NY.

“Anxiety and depression are, in fact, experienced by a large proportion of patients affected by [IBD],” he told Medical News Today.

“These comorbid conditions are also associated with worsened IBD outcomes,” said Dr. Honig.

According to Crohn’s & Colitis UK, feelings of stress, anxiety, or depression can trigger new symptoms in the gut.

A newly published study now suggests that IBD directly affects the brain by disrupting the gut-brain axis.

The gut-brain axis is a two-way channel of communication between the gut and the central nervous system. Microorganisms living in the gut play a prominent role in the relationship, although, as in this new study, findings to date are mainly in rodent models.

The new study found that inflammation in the gut may close a key gateway in this communication system that controls the exchange of signals between the blood and cerebrospinal fluid (CSF).

Unlike the blood-brain barrier, which prevents large molecules in the bloodstream from entering the brain, the gateway between the CSF and blood usually permits the passage of smaller molecules.

But the study found that it responds to inflammatory signals from the gut by slamming shut, presumably to prevent inflammation from spreading to the brain.

The research showed that in a mouse model of IBD, closure of the gateway disrupted memory and caused anxiety.

The research

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