BC Advantage - 2024 Issue 5

Understanding the Changes in the CMS-HCC Model V28

The New Year brought with it a long-overdue overhaul of the Centers for Medicare and Medicaid Services (CMS) hierarchical condition categories (HCC), ushering in the 28th version of the model used to assign risk adjustment factor (RAF) scores and estimate future healthcare costs for Medicare Advantage patients.   The upgrade aligns the underlying HCC methodology with the ICD-10-CM code set, which the rest of the healthcare system has been using since 2015. As such, it requires greater specificity in documentation and code assignment—both of which are imperative for accurate risk adjustment.   What's Different in V28   Designed...

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