Navigating CMS-HCC Version 28: Optimizing clinical documentation for reimbursement

Our experts get you up to speed on what you need to know for CMS’ three-year transition from CMS-HCC V24 to V28.
Navigating CMS-HCC Female Doctor on Computer

The introduction of CMS-HCC Version 28 (V28) will bring significant changes to the ever-evolving landscape of healthcare reimbursement – changes that will impact how healthcare organizations manage the three-year transition from the current V24 to V28.

To help providers to adapt and thrive in this uncertain environment, IMO turned to industry experts for insights on this latest HCC (Hierarchical Condition Category) evolution. Our on-demand webinar offers a comprehensive exploration of this change, providing strategies for effectively managing the transition. Topics covered include HCC reclassification, mapping strategies, and risk identification. Our goal is to help viewers like you to gain a clear understanding of the implications of V28 and empower you to confidently navigate these changes and optimize reimbursement outcomes.

Click below to watch the entire on-demand webinar, CMS-HCC Version 28: Get informed and be prepared for change.

For excerpts and clips from the discussion, continue reading below.

What are some of the guiding principles for clinical reclassification?

Vice President of Global Clinical Services at IMO, June Bronnert, MHI, RHIA, CCS, CCS-P, unpacks what clinical reclassification is and what was finalized by CMS. On March 31st, 2023, CMS published the announcement of calendar year 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. This document finalized proposed changes, including clinical reclassification, with a three-year-timeline for implementation. Watch the video below to learn about the methodology, specifically 10 guiding principles used for clinical reclassification.

What changes occurred between CMS-HCC V24 and V28?

V28 introduced several alterations to the HCC codes and names. In the video below, June provides a detailed comparison illustrating the differences, citing the liver disease group of HCCs as an example.

Understanding and adapting to these changes will help healthcare organizations ensure a smooth transition in their coding and risk adjustment factor (RAF) practices.

Identifying risk areas in mapping out changes from V24 to V28

In the webinar, June is careful to highlight the coexistence of both V24 and V28 during the transition period, emphasizing the need to manage two distinct systems simultaneously. Below are a few risks to be aware of during the shift and practical strategies to handle them.

  1. HCC Identification and Mapping: Accurately identifying and mapping HCCs from V24 to V28 is crucial. Understanding code changes, coefficient differences, and shifts in clinical meaning is essential to avoid inaccurate risk identification and payment impacts.
  2. Impact Analysis: Conducting a thorough impact analysis helps healthcare organizations identify significant V24 HCCs affecting their patient population and assess the changes coming in V28. Understanding what’s at stake enables the development of risk mitigation strategies and lays the groundwork for accurate financial reimbursement.
  3. Patient Transition and Documentation: Monitoring the movement of patients from complicated to uncomplicated HCCs is important, as it affects risk scores and subsequent payment. Proper documentation and coding practices – following MEAT (monitoring, evaluation, assessment, and treatment) guidance – remains essential, even for conditions no longer designated as HCCs in V28.

Ready to feel more confident in the change to CMS-HCC V28? Listen to the full discussion below.

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