HCC RECAPTURE – WHY IT’S IMPORTANT | January 2024 | Clinical Corner

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January 1, 2024

HCC RECAPTURE – WHY IT’S IMPORTANT

BACKGROUND:

Recapture Rate is the rate at which providers capture (code) recurring (or Chronic) HCC diagnoses on an annual basis. A standard goal is 85% recapture rate.1 The number (and severity) of chronic conditions is a predictor of costs, which are somewhat persistent from year to year. A drop in the risk score, possibly because of failures in capturing recurring diagnoses, could lead to lower financial benchmarks. This, in turn, could result in reduced financial allocations and reimbursements. This recapture rate is crucial in ensuring that healthcare providers are not financially penalized for taking care of patients with more complex and costlier health needs.

 

WHY IS IT IMPORTANT:

The better your recapture rate of previous Chronic Conditions, the more money received by healthcare organizations for distribution to eligible providers. As the number of Chronic Conditions increases, so do the costs of care and the percentage of spending, as shown in the table below.

 

Per Capita Spending in Medicare FFS Beneficiaries

WHAT CAN YOU DO:

  1. Address Chronic Conditions during the Adult Wellness Visit (AWV).
  2. You can ensure that Chronic Conditions are addressed even during acute or sick visits.
  3. Use combination codes, where two codes can be combined into a single code for a higher HCC.
    1. As an example, diabetes (E11.9 - HCC 19) and neuropathy (G58.9 – no HCC value) can be combined into a single code (E11.40 - HCC 18) which has a higher RAF value.
  4. Utilize your Persivia / Stanson Alerts (if applicable) to signal potential uncaptured diagnoses.
  5. Document stable conditions appropriately, even if there is no change.
    1. Example: MDD, recurrent, mild (F33.0) should be recaptured as MDD, recurrent, in remission (F33.42) next calendar year if stable on current regimen.
  6. Avoid using a diagnosis with the adjunct “unspecified”, be specific.
  7. Remember that all Chronic Conditions reset on January 1 each year and need to be recaptured each calendar year.

 

REFERENCE: 

  Kris Gates. What is HCC Recapture Rate? August 27, 2019 https://www.linkedin.com/pulse/what-hcc-recapture-rate-kris-gates-j-d-/