HCC Coding

by admin | October 27, 2023 | 0 comments,

HCC stands for Hierarchical Condition Category. It is a risk-adjustment model used by the Centers for Medicare and Medicaid Services (CMS) to adjust payments to Medicare Advantage plans based on the health status of their enrollees. HCC coding involves assigning a specific code to a patient based on their medical condition, which is then used to calculate the patient’s risk score. The risk score takes into account the patient’s age, gender, and health status, as well as any chronic conditions or comorbidities they may have.

The higher the risk score, the higher the payment that the Medicare Advantage plan receives for that patient. This is because patients with a higher risk score are expected to have higher healthcare costs, and the risk adjustment model helps to ensure that Medicare Advantage plans are adequately compensated for caring for these patients.

HCC coding is an important aspect of the Medicare Advantage program, as it helps to ensure that plans are paid fairly and that resources are directed to the patients who need them the most. It also provides an incentive for plans to focus on preventive care and chronic disease management, as these interventions can help to reduce the overall healthcare costs for their patients.