Risk Adjustment

Healthcare Insurance  ·  5 min read

HCC Coding Accuracy: The Revenue That Exists in the Clinical Documentation You Already Have

Each missed Hierarchical Condition Category costs approximately $80 to $100 per member per year in Medicare Advantage revenue. On a population of 100,000 members, closing 5 percent of coding gaps is worth $4 to $5 million annually. The documentation that supports those codes already exists in the clinical record. The gap is between the documentation and the submitted risk code.