Managing Medicare Advantage and Part D plans is no simple task, especially when it comes to Hierarchical Condition Categories, or HCCs. CMS provides health plans with risk-adjusted payments that are based on each member’s HCCs. On average, each HCC is worth $250 per member per month. The more HCCs a member has, the higher the risk score—and the greater your potential reimbursement from CMS.But getting accurate claims data can be tough. There are more than 3,000 diagnostic codes that can map to member HCCs, and the potential for error is great. When claims are inaccurate or diagnosis data is incomplete, your health plan may not get fully reimbursed by CMS, and that means a loss of income. That’s where TriZetto can help.
TriZetto’s solution for managing HCC revenue, the TriZetto HCC Risk Adjustment Manager, can help you improve the accuracy of risk-adjusted payments. This easy-to-use solution gives you the tools to:
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TriZetto provides leading healthcare IT solutions for payers and providers. TriZetto promotes integrated care management by offering comprehensive solutions for care management software, claims management services, network management solutions and more. With solutions for care management, patient-centered medical home (PCMH) solutions, payment bundling and other innovative models, TriZetto is helping reduce the cost, improve the quality of care and transform the healthcare industry.