The Princess Diaries: From Coding Commoner to HCC Royalty

Last week, we had our Usher moment — that deep sigh of recognition when you realize your risk scores are way too low for the complexity you’re managing. You saw the disconnect between what’s really happening in your exam rooms… and what the data says on paper.

This week? It’s time to fix it.

Because once you see the problem, you don’t stay stuck in it. You shift from survival mode to strategy — and that’s when everything changes.

Enter: HCC coding mastery. The hidden gem of value-based care success.

What Risk Adjustment Really Does

Risk adjustment isn't just about getting paid more — it’s about getting what you need to care for patients with real complexity.

HCC (Hierarchical Condition Categories) coding is how systems try to level the playing field. It says: if you're caring for sicker patients, you should get more resources to do that well.

But if you’re documenting “diabetes” when your patient has “Type 2 diabetes with nephropathy”… the system can’t see how much work you're actually doing.

No detail means no credit, which means no support.

The Shrug-and-Send Trap

Most practices aren’t failing because of poor care. They’re just not telling the full story.

The risk score gap usually isn’t about laziness — it’s about missing systems.

• Problem lists don’t get updated

• Templates don’t prompt for specificity

• Coders aren’t looped into the clinical picture

• Clinicians don’t have time to “code better” without help

You’re doing the work. Now let’s make sure it counts.

What Coding Royalty Actually Looks Like

It’s not about memorizing ICD-10 codes or doing a three-hour deep dive on risk weights. It’s about building a repeatable system that works with your clinical flow, not against it.

Start here:

• Add chronic condition prompts to every visit

• Use smart phrases for specificity (e.g. “chronic systolic heart failure”)

• Review problem lists regularly

• Empower coders to ask clinical questions

• Create simple feedback loops between coders and clinicians

Celebrate the small wins. When your score finally matches what you know to be true, that’s the validation you’ve been waiting for.

Make It a Team Thing

Coding isn’t a solo sport. Coders, clinicians, and admin staff all need to work in sync.

• Coders need clinical context

• MAs can help review chronic conditions

• Leaders should support training and system updates

• One person should own HCC performance tracking

It doesn’t have to be perfect. It just has to be intentional.

Let Your EHR Carry Some of the Load

Stop letting your EHR act like a glorified notepad. Configure it to:

• Flag unresolved chronic conditions

• Prompt for specificity when vague terms are used

• Track trends in risk scores over time

• Integrate notes from specialists or hospital stays

• Offer coding suggestions that actually support your process

And if your panel is large or your contracts are growing in complexity, consider outside tools or consulting support to help scale your strategy.

The Real Win: Better Care, Not Just Better Scores

Risk adjustment done right gives you:

• Resources for care management

• Realistic benchmarks for quality performance

• More sustainable value-based contracts

• A team that understands why the details matter

But most importantly — it gives your patients the level of care they actually need.

Final Word

You’ve already had your Usher moment. You know the risk score system isn’t telling the whole truth.

Now it’s time to fix the narrative — not with more clicks, but with smarter systems, stronger teams, and a commitment to showing the real complexity behind the care you provide.

You’re not a coding commoner. You’re a clinician doing exceptional work — and you deserve the support, recognition, and resourcing that comes with that.

Let’s make sure the data finally reflects the reality.