Auditing HCCs: Driving Compliance and Revenue Integrity

Ensuring comprehensive clinical documentation and obtaining the key elements will help improve coding accuracy, reduce denials and obtain revenue integrity.
Audits of Hierarchical Condition Categories (HCCs) have been performed for years as a way for Part C vendors (Medicare Advantage Organizations) to support their data submission for chronic condition category revenue. The Office of Inspector General (OIG) has been focusing on HCC compliance for several years now and continues with the 2020 Work Plan.

CMS estimates that 9.5 percent of payments to MA (Medicare Advantage) organizations are improper, mainly due to unsupported diagnoses submitted by MA organizations. Auditing HCCs takes an astute knowledge of documentation and coding guidelines and regulations. Knowing the problematic diagnosis can assist in your auditing efforts and meeting compliance.

Join the renowned coding and compliance expert, Gloryanne Bryant, to review and understand the key aspects of auditing HCC and obtaining compliance.

Session Objective

• Achieving Accurate HCC and ICD-10-CM code assignment


• Obtaining Compliant reimbursement for HCCs and Auditing Practices


• Understanding the ICD-10-CM coding instructions for common problematic HCCs


• Review OIG findings and future plans for HCC compliance


• Understand the compliance risks with HCC, documentation and ICD-10-CM coding.


• A Review of the OIG and RAC HCC coding compliance risks


• Provide auditing information on where to obtain details on coding compliance risks and red flags


• Understand the key auditing steps and strategies to diminish compliance gaps and vulnerabilities


• Walk through some HCC case scenario’s


• Address coding compliance questions and best practices

Session Agenda

• What key documentation to obtain to support the HCC and ICD-10-CM codes and avoid compliance issues and denials?


• How do we conduct HCC audits proactively to ensure documentation and coding accuracy?


• Are you prepared for an audit of your HCC data, documentation and ICD-10-CM coding?


• Do you understand HCC problematic diagnosis, documentation and coding? These can assist with achieving compliance and revenue integrity.

Who Should Attend

• Coding Supervisor/Manager – Outpatient and Inpatient


• Outpatient Coding Auditor


• Outpatient Coding Educator


• HCC coding staff


• Coder/Coding Professional (outpatient setting)


• Clinical Documentation Improvement Specialist


• Coding Compliance Specialist/Manager


• Hospital ER and Inpatient coding professional


• Physician Office Coding Staff

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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