New Infographic: Ensure Accurate Reimbursement and Risk Capture with HCC Coding Best Practice Checkup

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PYA (Pershing Yoakley & Associates, P.C.), a national management consulting and accounting firm, has released a new infographic that gets to the core of risk management and its impact on reimbursement, and the importance of implementing a best practice checkup for hierarchical condition categories (HCC) coding.

hierarchical condition categories (HCC) coding infographic

Ensure Accurate Reimbursement and Risk Capture with HCC Coding Best Practice Checkup

A change in the risk score can significantly affect the total payment received as part of the program

Inaccurate HCC coding can lead to significant financial implications and variability in Risk Adjustment Factor scores. A new infographic released by PYA illustrates why coding accuracy is paramount and how implementing a best practice HCC “periodic checkup” is essential to the solution.

“Providers participating in a Medicare Advantage or other risk-based healthcare plan whose payment is tied to money the plan receives should have a vested interest in accurately documenting and capturing diagnosis codes for each patient,” said PYA Healthcare Consulting Principal Lori Foley. “Accuracy in risk capture not only leads to a better determination of the health status for a population, it also results in correct and accurate payment.”

PYA’s infographic, “The Core of Risk Management: Implement an HCC Best Practice—PYA’s HCC Checkup,” demonstrates for providers the importance of accurate documentation and diagnosis code capture for success in their risk-based contracts and for quality of care management of their patients. It advocates for establishing a best practice, or HCC Periodic Checkup, which can help providers overcome common coding and documentation errors that lead to inaccuracies and the resulting financial impact.

“Risk-based healthcare plans depend on the diagnosis codes reported by providers to build the health-risk profile of each beneficiary; and risk scores are used to adjust payments,” said Foley. “As shown in the infographic examples, a change in the risk score can significantly affect the total payment received as part of the program.”

Less than thorough HCC patient coding is often undetected, therefore an assessment by an independent and objective third party with the right data analysis tools can pinpoint areas of deficiency. Conducting periodic checkups helps organizations determine any corrections to their risk-adjustment factor scores, potential underpayments, or increased risk of overpayments that need addressing prior to the annual governmental audit.

PYA offers an HCC Periodic Checkup that employs computational data analytics to improve coding accuracy and appropriate reimbursement. Drawing on its extensive clinical background, PYA’s multidisciplinary team is able to assist large or small care environments by providing unbiased assessments of HCC accuracy without disrupting workflow. The team conducts education and training to show physicians and office staff ways to leverage best practices to ensure future coding accuracy improvement, as well as provides operational assessments, including electronic health records analysis.

About PYA

For over three decades, PYA (Pershing Yoakley & Associates, P.C.), a national healthcare consulting firm, has helped clients navigate and derive value amid complex challenges related to regulatory compliance, mergers and acquisitions, governance, business valuations and fair market value assessments, multi-unit business and clinical integrations, best practices, tax and assurance, business analysis, and operations optimization.

PYA’s steadfast commitment to an unwavering client-centric culture has served the firm’s clients well. PYA is now ranked by Modern Healthcare as the nation’s 9th largest privately owned healthcare consulting firm. PYA affiliate companies offer clients world-class data analytics, professional real estate development and advisory resources for healthcare providers, comprehensive claims audits for self-insured Fortune 500 companies, wealth management and retirement plan administration, and business transitions consulting.

PYA assists clients in all 50 states from offices in Atlanta, Kansas City, Knoxville, Nashville, and Tampa. For more information, please visit

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