Stream: implementers
Topic: HCC- Codesystem and Resource
Pranathi Reddy (Jun 10 2020 at 23:01):
Hi All,
I was trying look for a resource that can be used to populate HCC ( described below) derived for a Patient and codesystem associated to it.
The closest resource I was able to find is "Condition",
but wanted to know if anyone has experience in using HCC in FHIR resources or have any better suggestion ?
Hierarchical Condition Category (HCC) coding is a risk adjustment payment model mandated by the
Centers for Medicare and Medicaid Services (CMS).
There are more than 9000 ICD-10 codes that map to more than 70 HCC codes in the model.
Thanks in advance.
Lloyd McKenzie (Jun 11 2020 at 00:46):
@Paul Knapp @MaryKay McDaniel
MaryKay McDaniel (Jun 11 2020 at 15:09):
I'm from the administrative side of the house so with not a great deal of analysis, it seems to me this should be on the Coverage Record. The person (patient) must be enrolled in a Medicare Advantage Plan for the HCC to matter. The HCC Category is how much the Plan would be paid (capitated) for the member. Guessing the patient's HCC score doesn't change from MA plan to MA plan, but the payment amounts may. HCC scores can change as a patient's condition changes, but as I understand it the HCC only changes for 'payment' by plan year (need to confirm this statement)....
Would the patient be treated any differently if practitioners knows what the HCC is?
And what documentation does CMS currently require - outside of the encounters submitted?
Seems like a good conversation for a future FM call.
MK
Pranathi Reddy (Jun 12 2020 at 01:53):
Thanks for your response . JUst wanted to correct from my question that this is not related to any CMS documentation(i was only mentioning to give details on HCC)
but my use cases are
1) Provide an output identifying HCC's of a Patient ,HCC factors score based on the conditions patient has(for Payors).
2) Represet Suspect HCC and suspected Conditions that will be used by practitioners to Assess/treat the Patient accordingly .
So i was looking for a representation/FHIR resources where i could present HCCs in resources .
MaryKay McDaniel (Jun 12 2020 at 04:22):
Well, you've moved me way outside my comfort range. AND I am NOT well versed in the Clinical Resources, but it seems like this is almost a RiskAssessment. All the 'conditions' would have been documented in a condition resource. Wouldn't what you are really attempting to do is gather all the conditions (i.e., diagnosis) to match against a smaller set of HCCs at a particular point in time. The overall 'result' is the HCCs identified and a score?
Hopefully others who understand the RiskAssessment could offer up an opinion?
Last updated: Apr 12 2022 at 19:14 UTC
