HCCs under CMS and HHS: Can you spot the difference?

Hierarchical Condition Categories (HCCs) are important for many healthcare needs – but what exactly is the difference between CMS and HHS’ programs? Test your knowledge below.
Guide to HCCs

In healthcare, many of us know how important Hierarchical Condition Categories (HCCs) are for patient care, as well as billing and reimbursement needs. It might even seem obvious that there are two different HCC programs – one through the Centers for Medicare & Medicaid Services (CMS) and a second through the Department of Health and Human Services (HHS).

But, how well do you know the differences between each program? Test your knowledge with the five facts below by choosing whether each is a CMS or an HHS truth (or both!).

  1. HCCs under _____ were designed to cover the majority of the population – anyone who is eligible to purchase health insurance on the marketplace must be considered in coverage.
  1. _____’ program for HCCs and RAF scores is based on the initial plan developed by _____ and used for Medicare Advantage patients.
  1. The _____ plan does not include HCC calculations for acute illnesses – its goal is to assess the future cost of long-term conditions and be predictive of ongoing healthcare costs.
  1. To calculate RAF scores, _____ uses data collected about HCCs from the previous year. This means that payment in the current year is based on diagnoses from the year before.
  1. _____’ HCCs account for both chronic and acute conditions, like maternity care and organ transplants. They include adult, child, and infant models.

BONUS: Every April, _____ updates its list of HCCs – effective for the upcoming year.

Ready to see how you did? Download A guide to HCCs for CMS and HHS and how RAF scores relate to find the answers and learn more about the similarities and differences between these two important programs.



Answers: 1. HHS 2. HHS, CMS  3. CMS 4. CMS 5. HHS 6. (Bonus) Both

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