Risks and Returns: Maximizing HCC Reimbursement in a Value-Based World

By Eric McGuire, CRCR, PgMP, PMP, LSSGB


As healthcare moves from a fee-for-service to a value-based care model, the financial risk rapidly shifts from payers to providers. To thrive in this environment, provider organizations must enhance documentation, align evidence, and improve coding quality to achieve the highest possible reimbursement. Future healthcare spending will rely on risk adjustment models for the purpose of forecasting patient care costs across higher-risk populations, aligning to population health efforts and aiding payers and provider organizations in forecasting costs.

Is your organization missing out on potential HCC reimbursement revenue? Hear from Eric McGuire, SVP of Coding Services at AGS Health, as he provides a comprehensive overview of risk adjustment and HCC coding, including the various models, requirements, and practices for success. Find out how risk adjustment coding and HCCs can positively impact your bottom line while improving your ability to forecast costs and improve patient satisfaction.

Learning Objectives:

  • Get a detailed look into the differences between fee-for-service and value-based care models.
  • Learn about risk adjustment and HCC coding, including the differences between the CMS and HHS models and when they are applied.
  • Gain insights into the additive nature of HCCs, how they work, and the significance of RAF scores.
  • Discover the financial impact of HCC coding and learn how outsourced HCC coding services can quickly generate additional revenue for your organization.
Eric McGuire

Eric McGuire, CRCR, PgMP, PMP, LSSGB


Eric is a seasoned HIM and revenue cycle professional with more than two decades of experience in helping healthcare organizations bridge the gap between healthcare IT and business operations. As the senior vice president of coding and CDI services, he leads the development of service line strategy and execution. Eric’s leadership and consultancy has helped numerous customers transform their revenue cycle outcomes through enhanced patient experience, revenue growth, risk mitigation, and cost containment. Eric possesses a bachelor’s degree in Macroeconomics from The Ohio State University in Columbus, OH.

Duration: 60 Minutes
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Webinar – Risks and Returns: Maximizing HCC Reimbursement in a Value-Based World