Hierarchical Condition Categories, or HCCs, affect how CMS and Medicare Advantage plans calculate risk scores and payments. For practices with a significant Medicare Advantage patient panel, accurate HCC coding is not just a compliance matter. It is a revenue matter.
Most rounding physicians know HCC coding exists. Fewer have a reliable workflow to capture it consistently.
HCC coding requires documenting chronic conditions - not just the reason for the current visit. A patient seen for a wound assessment who also has diabetes with complications needs both conditions documented in the note if the diabetes is assessed or managed during the visit.
The challenge in rounding workflows is that visit notes are often brief by necessity. The pressure to move between rooms leads to notes that document the immediate problem and skip chronic conditions that were not the primary reason for the encounter.
Over a year, the gap between the conditions present in a patient panel and the conditions documented in notes creates a risk score that underrepresents actual patient complexity. For Medicare Advantage plans, a lower risk score means lower capitation payments.
Based on patterns seen across LTPAC practices:
Conditions documented in prior notes but not carried forward - if a patient's heart failure is not documented in the current note, it may not be counted in the annual risk calculation
Specificity of diagnosis codes - HCC coding depends on using the most specific ICD-10 code available. Coding diabetes without specifying the type and complications leaves points on the table.
Secondary diagnoses on each encounter - rounding notes often capture one or two diagnoses; the full list of managed conditions for a complex patient is longer
An EHR that supports HCC coding in a rounding workflow should:
Surface all documented chronic conditions for a patient during each encounter, not just the current visit's primary diagnosis
Support multi-code entry without requiring extra steps per diagnosis
Include ICD-10 specificity guidance at the point of coding
Enable Pull Forward of prior diagnostic information as a starting point
If your current EHR requires you to manually review prior notes and re-enter chronic conditions at each visit, you are doing work that should happen automatically - and likely missing some conditions in the process.
For a small rounding practice with a Medicare Advantage patient panel, improving HCC capture rate by capturing two additional conditions per patient per year can meaningfully affect risk scores and plan payments. The exact dollar impact varies by payer and contract, but practices that track this consistently see measurable improvement when documentation workflows are structured to capture it.
EasyRounds supports structured multi-diagnosis documentation and includes clinical decision support that helps prompt complete coding during encounters. If HCC accuracy is a priority for your practice, we can show you what the workflow looks like.