Accurate risk adjustment isn’t just a box to check; it’s now a strategic lever. Hierarchical Condition Category (HCC) coding underpins risk scores that drive Medicare Advantage and other value-based ...

"Modifying the HCC model is not a simple technical update or revision," the AMGA says. CMS recently released proposed changes to the CMS-HCC Risk Adjustment Model for payment year 2024 in February, ...

United States, 7th Aug 2024 - In the realm of healthcare, precision is everything. The accuracy of Hierarchical Condition Category (HCC) risk scores plays a pivotal role in the financial health of ...

Healthcare coding has fundamentally transformed from volume-driven revenue capture to compliance-first, defensible documentation standards.

CMS uses the HCC score to mitigate selection incentives due to difference in average costs between beneficiaries with different HCC scores. Paradoxically, the way CMS calibrates the HCC bolsters MA ...

These gradual changes to risk adjustment are a step in the right direction, but there are other ways to get differential coding under control that CMS is not considering implementing. On January 31, ...

The Centers for Medicare & Medicaid Services (CMS) recently released its 2026 Medicare Advantage (MA) Rate Announcement, projecting a 5.06% average increase in payments to MA plans — a significant ...