Each HCC is mapped to an ICD-10-CM code. Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor …

The Centers for Medicare & Medicaid Services (CMS) uses HCC scores to adjust payments for Medicare Advantage plans and some fee-for-service programs. A higher HCC score reflects …

May 1, 2025 · HCC coding is necessary to communicate patient complexity and ensure an accurate ‘digital twin’ in the electronic health record (EHR). This, in turn, helps determine risk …

Patients that are healthier than average will have an HCC score below 1.000 and those that are less healthy than average would have a score above 1.000. The following examples illustrate …

Hierarchical Condition Category (HCC) is a term that describes the grouping of similar diagnoses into one related category to be used in a risk adjustment model

Jun 11, 2025 · HCC stands for Hierarchical Condition Category. It’s a risk adjustment model developed by the Centers for Medicare & Medicaid Services (CMS) to estimate future …

Aug 25, 2025 · As healthcare shifts to value-based care, accurate HCC coding and RAF scoring are vital for reimbursement and compliance. This guide highlights best practices, challenges, …

For these reasons, it is important for health centers to have an HCC coding strategy to ensure patient diagnoses are documented thoroughly and to the highest specificity possible. This …

Created by CMS in 1997, HCC or “Hierarchical Condition Category” is a risk adjustment model to calculate risk scores for Medicare beneficiaries. HCC scores reflect expected annual medical …

The Centers for Medicare & Medicaid Services (CMS) uses a Hierarchical Condition Category (HCC) risk adjustment model to calculate patient risk scores to predict health care costs based …