The end of year is typically the most critical time for managed care organizations and health care providers to reconcile hierarchical condition category (HCC) and risk adjusted factor (RAF) scores. […]

For the past year, I’ve been immersed in the world of hierarchical condition category (HCC) coding. It’s been a great opportunity to dig deeper into everything related to risk adjustment […]

In my last blog, HCCs: An awareness perspective, I introduced you to Mike, a 66-year old white male with type II diabetes mellitus (DM) and congestive heart failure (CHF). I […]

The idea that, at some point in each of our lives, we may become acutely ill, eventually leading to the development of a chronic medical condition is a very real […]

As a clinical documentation integrity (CDI) and coding professional, I’ve often heard the statement: If it’s not documented, it wasn’t done. I have used this statement educating physicians and nurses […]

I sat down with 3M Health Information Systems Global Chief Medical Officer Sandeep Wadhwa, MD, MBA, to discuss clinical and financial risk management, and risk stratification with Medicare Advantage plans. […]

According to the Center for Disease Control’s National Diabetic Statistics Report 2020, there are 34 million people in the United States that have diabetes. That is 11 percent of the […]

As Medicare Advantage (MA) organizations report chronic disease conditions using ICD-10-CM encounter data to the Centers for Medicare and Medicaid Services (CMS) for use in the hierarchical condition category (HCC) […]

Hierarchical Condition Categories (HCCs) have been used in the Centers for Medicare & Medicaid Services (CMS) risk adjustment payment model since 2004. That’s 17 years! More and more HIM professionals […]

Audits of Hierarchical Condition Categories (HCCs) have been performed for years as a way for Part C vendors (Medicare Advantage Organizations) to identify and support patients with complex needs. Higher […]

In my previous blog, I took a hard look at the impact of mental health and substance abuse on hospital readmissions, especially the torrent of patients with these issues coming […]

So there are PPCs and HACs, PPRs and PPAs, PSIs and VBP just to name a few. But please don’t forget or underestimate the importance of HCCs. Why should you […]