To provide the best possible healthcare to your patients, it is important that your healthcare providers are up to the task. But, how can you ensure that the healthcare providers you hire are competent and qualified for the job. Provider credentialing is the best way to compare, evaluate and verify the qualifications and competency of the healthcare providers that you are hiring.
HCC scores have been used since 2004 by Medicare to adjust payments based on the risk level of the enrollee. This has resulted in Medicare paying a higher monthly capitation fee for patients with higher HCC scores as these patients require more resources and disease intervention. The HCC payment system uses ICD-10 codes and demographics to generate a risk adjustment factor (RAF) score which identifies patients that require higher cost to care for and is based on the diagnosis codes billed in the previous review period.