
Hierarchical Condition Category (HCC) services from 3M
 Educate organizations to understand HCC methodology
 Evaluate an organization’s current readiness state
 Analyze an organization’s HCC Risk Adjustment Factor (RAF) score
What are HCCs?
The challenge: Report patient diagnoses across the care
CMS developed hierarchical
continuum for one year
condition categories (HCCs) to
Reimbursement methodologies are continually changing to
adjust Medicare capitation
incorporate risk adjustment based on a patient’s health.
payments for Medicare Advantage The goal is to equalize payment across the population.
plans (Part C), based on the health
expenditure risk of their enrollees. HCCs are captured over the span of a year by documenting
HCCs use a risk-adjusted score
the highest disease categories for each patient’s conditions.
that includes patient diagnosis and HCC data is used to calculate an HCC risk adjustment
demographic information.
factor (RAF) for an entire year’s worth of a patient’s
encounters across the continuum of care. Diagnoses from
HCCs were then developed for the inpatient, outpatient and professional practice encounters
commercial payer market using
are used to calculate the RAF score, so your organization’s
the CMS HCC methodology as a
success with HCCs relies on understanding the implications
starting point. Modifications were of accurate and complete documentation and coding.
added for the different age ranges
found in the commercial
And the sooner you understand the complexities of HCCs,
population of patients.
the sooner you can realize the benefits of appropriate risk
adjustment calculation. Does your current data reflect
CMS HCCs are also used as a
accurate HCC risk scores for your patient population based
factor in calculating the total
on reported diagnoses? Once ICD-10 is implemented, the
performance score (TPS)
increased specificity requirements may cause changes in
under the Hospital Value-Based
these disease categories. Is your organization prepared for
these changes and potential impacts?
Purchasing (VBP) Program.
The solution: Healthcare consultants who really know
documentation and coding
Armed with extensive healthcare coding compliance and
clinical backgrounds, the physicians, nursing and coding
experts from 3M Consulting Services have a proven track
record in providing quality and sustainable coding and
documentation improvement programs to more than

1,500 hospitals nationwide. 3M consultants
understand HCCs inside and out. They know
how to implement a program to assist an
organization in reporting accurate patient
diagnoses, so their risk scores reflect their
patient population.
And because 3M’s HCC services are
modular, 3M consultants provide just the
right mix of services targeted to meet your
organization’s specific needs.
What we offer
3M’s comprehensive HCC Assessment
and Educational Services are delivered by
the industry-leading experts on coding,
documentation improvement and
reimbursement methodologies.
These services are designed for hospital
inpatient and outpatient facilities and
professional practices that need help
understanding and implementing HCCs
into their concurrent processes.
3M experts provide a comprehensive
assessment of the current state of HCC
capture. Based on the results of the
assessment, educational programs are
designed for physicians, coding and clinical
documentation improvement (CDI)
professionals and physician office staff.
An executive summation meeting includes
a management overview of HCCs,
results of the assessment findings and
recommendations for improvement.
In the Comprehensive HCC Train-theTrainer Program, 3M experts assist you in
establishing an HCC program that spans the
continuum of care. We work with your staff
to create a self-sustaining HCC program that
allows for ongoing monitoring to ascertain
optimal documentation for HCC coding and
reporting. The program can be integrated
into existing CDI programs or used as a
standalone program based on the needs of
the organization.
With the HCC Audit Service,
3M consultants evaluate claims data
extracted for inpatient, outpatient and/or
professional services. They perform medical
record assessment by combining both
focused and random samplings to evaluate
for accuracy and the presence of additional
reportable diagnoses with provision of codes
for documented diagnoses.
Call today
For more information on how 3M software
and services can assist your organization,
contact your 3M sales representative, call us
toll-free at 800-367-2447, or visit us online
at www.3Mhis.com.
Health Information Systems
575 West Murray Boulevard
Salt Lake City, UT 84123
U.S.A.
800 367 2447
www.3Mhis.com
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Diseases and Related Health Problems –
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© 3M 2015. All rights reserved
Published 04/15
70-2011-6561-3