Medical Reimbursement Specialist

Medicare Risk Adjustment Data or Hierarchical Condition Categories (HCC)

Moving from v24 to v28 on January 1, 2024!

Call our office today to prepare for the transition. If you have a high percentage of Medicare Advantage patients, being prepared for this transition is crucial to your continued healthy bottom line.

Request a copy of 2024 deleted and NEW codes!
** The HCC handout is also available with RAF to analyze its impact on your bottom line. Please call the office to request: 562-430-6847 or email vimenchaca@reimbursementspecialist.com.

What is a CMS-HCC Chart Review?

Some chart reviews are done to ensure that deserved reimbursement reaches your practice. The HCC Chart Review is one example.

Through a CMS-HCC chart review, the reviewer gleans out of your documentation those codes that may have been missed by the provider; or that may have been omitted from the encounter data submission; or that you may have been unaware merited a separate condition code. Submitting these by the deadline date guarantees that your payments will reflect deserved reimbursement.

As part of the process, you will receive tips on how to improve your documentation to support the diagnosis code assignment.

Your 2024 payments for patients in a Medicare Managed Care plan are based on the diagnoses submitted for those patients in 2023. 2024 payments are a blended rate of 67% v24 RAF plus 33% v28 RAF.

Our staff of certified coders are experienced in abstracting charts for this vital information. We have extensive experience in providing bilingual (Enlish/Spanish) guidance in this area.

How does CMS-HCC work?

Health status eventually replaces demographics factors as adjustment
Focal point is complete and accurate coding
Multivariate models sum points or weights for multiple factors to score an enrollee
Each enrollee gets a score based on which factors were present (e.g. 10 points for cancer plus 1 point for pneumonia plus 5 points for asthma yields 16 points)
2007 was the first year for reimbursement 100% based on this Risk Adjustment Data. Payments for Medicare Advantage patients have been based entirely on the diagnosis coding assigned by you!

What you can do today -

Initiate a task force to start addressing the transition to 2024 blended payment rate using both v24 and v28 RAF

Provide education for all providers on appropriate documentation

Train in-house coders to recognize HCCs while abstracting

On-going audits addressing HCC coding and documentation

Implement feedback mechanism for continous improvement

Get a baseline audit for your group and improve revenue

Access a complete list of HCCs directly from Medicare here: HCC.

** The HCC handout is also available with RAF or Category. Please call the office to request: 562-430-6847.