In the world of healthcare, understanding the significance of Hierarchical Condition Category (HCC) codes is paramount. These codes aren’t just strings of characters; they are key to securing accurate reimbursement and providing comprehensive patient care.
And now that the Centers for Medicare & Medicaid Services (CMS) has finalized far-reaching policy updates for Medicare Advantage (MA) plans in the Medicare Advantage Rate Notice for 2024, significant revisions have been made to the risk-adjustment model that affect HCCs.
We created this blog to serve as a reference point – a gateway to understanding the importance of HCCs and the upcoming shift to the 2024 CMS-HCC Version 28 model.
(Psst. If you’re hoping to lookup a specific HCC code, you’ve got the wrong site – sorry).
HCC 101: Why they matter
Need a refresher on the concept of HCCs and their relevance not only to reimbursement but to the push organizations are making towards value-based care? Look no further.
- HCC 101 – Learn what HCCs are, how they are used, who uses them, and how they impact reimbursement.
- How clinical documentation impacts revenue cycle management – Capturing secondary codes during clinical documentation can have a substantial impact on both HCCs and reimbursement. It is crucial to understand how capturing secondary codes and HCCs can impact an organization’s bottom line.
HCC V28: What you need to know
In March of 2023, CMS unveiled substantial modifications to the HCC model, a transition that will span three years beginning in 2024.
This announcement has prompted healthcare organizations nationwide to focus on understanding the changes, evaluating their financial implications, and creating strategies to effectively navigate this consequential shift.
In this guide, IMO’s Vice President of Global Clinical Services, June Bronnert, MHI, RHIA, CCS, CCS-P, takes a closer look at what’s driving the model modifications, the differences between the versions – and the challenges they pose, along with concrete steps that can be taken to prepare for the upcoming changes.
To get the guide, click the button below.
Can you stream it? Yes, you can.
For those who prefer visual learning, our on-demand webinar may be more to your liking.
- CMS-HCC Version 28: Get informed and be prepared for change – Watch this webinar with Bronnert and David Arco, Director, Product Management, for an in-depth look at the CMS-HCC Version 28 model, potential implications, and strategies from IMO on managing the transition.
Additional reading on V28
Looking for an even deeper dive? Here are just a few of the additional articles that you can find on our Ideas blog.
- A primer on the CMS-HCC transition from V24 to V28 – This article includes clips from our on-demand webinar and provides highlights of V28.
- Q&As about CMS-HCC V28 – From the same webinar, see what attendees asked during the Q&A session. Maybe you’ll see your question there too.
- Navigating CMS-HCC Version 28: Optimizing clinical documentation for reimbursement – Review the changes that occurred between V24 and V28.
