[epicproviders] Effective 04/01/2024: IMO Files UPDATED

[Epic - All Provider Staff]

Diagnosis codes have been updated as of 4/1/24. A feature has been turned on to give providers a visual cue when an ICD 10 code is part of a CMS Hierarchical condition category (HCC). HCC Diagnosis allow us to demonstrate the complexity of our patients to payers which can in turn impact the amount of revenue we receive.

Why is HCC coding important?
Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics. By accounting for differences in patient complexity, quality and cost performance can be more appropriately measured.

Risk Adjustment and Value-Based Payment
Risk adjustment can play an important role in payment, and this is particularly true in value-based payment (VBP). VBP arrangements use a practice's performance on cost and quality metrics to determine revenue, which means risk adjustment can have a direct impact on a practice's revenue. When risk scores do not accurately reflect patient complexity, it may appear patients had higher costs and/or lower quality outcomes than would be expected. In certain payment models, this may cause a practice to fall below quality and cost performance targets and potentially miss out on the opportunity for shared savings.

In other models, such as capitation, a practice's payment rate may be based on a patient or practice's average risk score. For example, in Primary Care First, the population-based payment (PBP) is calculated using the average RAF of the practice's attributed beneficiaries. Practices with more complex patients, based on RAF scores, receive a higher PBP as it is expected their patients will require more resources and have higher utilization.

The American Academy of Family Physicians. (2020, January 9). Hierarchical condition category coding. AAFP. https://urldefense.com/v3/__https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/hierarchical-condition-category.html*:*:text=Hierarchical*20condition*20category*20(HCC)*20coding*20is*20a*20risk*2Dadjustment,health*20care*20costs*20for*20patients__;I34lJSUlJSUlJSUlJSU!!GobTDDpD7A!J4CCpA-Be8vn6hqelh0-9zEmQMWFY50VnogdBkOQJzBOTlqZG4PI8TS45oOp3qNAWZ_kO6_o4uZ-KIFNT8FZtX1Y39dz$ <https://urldefense.com/v3/__https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/hierarchical-condition-category.html*:*:text=Hierarchical*20condition*20category*20(HCC)*20coding*20is*20a*20risk-adjustment,health*20care*20costs*20for*20patients__;I34lJSUlJSUlJSUlJQ!!GobTDDpD7A!J4CCpA-Be8vn6hqelh0-9zEmQMWFY50VnogdBkOQJzBOTlqZG4PI8TS45oOp3qNAWZ_kO6_o4uZ-KIFNT8FZte6zp4sC$ >.


Thank you,

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