What Is An HCC?
HCCs (Hierarchal Condition Categories), are disease groups broadly organized into body systems, and the diagnoses within each disease group are clinically related in terms of cost to the Medicare program. The CMS Risk Adjustment Model includes more than 3,000 ICD-9-CM* codes in the payment model that map to approximately 87 HCCs*. These HCCs dictate the premiums paid to a Medicare Advantage plan. The HCC codes correlate to ICD 9 CM diagnosis codes. A patient may have more than one HCC category assigned to them. Since the CMS model is cumulative, each additional diagnosis code results in an increased payment to the Plan. Many categories also override other categories -hence, a hierarchy of categories/diagnoses.
* The number of ICD9's that Risk Adjust change annually, as does the number of HCC /RxHCC codes - these numbers are dynamic not static
HCCs (Hierarchal Condition Categories), are disease groups broadly organized into body systems, and the diagnoses within each disease group are clinically related in terms of cost to the Medicare program. The CMS Risk Adjustment Model includes more than 3,000 ICD-9-CM* codes in the payment model that map to approximately 87 HCCs*. These HCCs dictate the premiums paid to a Medicare Advantage plan. The HCC codes correlate to ICD 9 CM diagnosis codes. A patient may have more than one HCC category assigned to them. Since the CMS model is cumulative, each additional diagnosis code results in an increased payment to the Plan. Many categories also override other categories -hence, a hierarchy of categories/diagnoses.
* The number of ICD9's that Risk Adjust change annually, as does the number of HCC /RxHCC codes - these numbers are dynamic not static