What are hierarchical condition categories?

HCCs, or Hierarchical Condition Categories, are sets of medical codes that are linked to specific clinical diagnoses. Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions.

What is the difference between CMS-HCC and HHS HCC?

“Code all documented conditions, which coexist at the time of the visit that require or affect patient care or treatment….How to use this information in practice.

CMS-HCC	HHS-HCC
Developed for >65 year olds and disabled patients of all ages	Developed for all age patients

What is the difference between HCC and RAF?

HCC codes are additive, and some have multipliers. Population complexity/severity affects payment in many Medicare contracts. RAF is used for benchmarking for quality and safety. RAF enables identification and stratification for patient management.

How many HCC categories are there?

In this Timely Topic, we provide an introduction to the HCC system. Of the approximately 70,000 ICD-10-CM codes, about 9,500 map to 79 HCC categories. The diagnoses must be documented by the physicians who provide care. A Risk Adjustment Factor is assigned to each HCC category.

What is hierarchical condition category coding?

Hierarchical Condition Category Coding Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients.

What is the CMS-HCC model?

Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. Hierarchical condition category relies on ICD-10 coding to assign risk scores to patients. Each HCC is mapped to an ICD-10 code.

Which Medicare program is affected by CMS-HCC?

The CMS-HCC risk adjustment model is used to adjust payments for Part C benefits offered by MA plans and PACE organizations to aged/disabled beneficiaries. The CMS- HCC model includes both diseases and demographic factors.

What are the advantages of hierarchical coding?

Since hierarchical design lets you enter a large design one piece at a time, it helps to organize and structure you design. By structuring your design you are more clear of what each module in your design should contain. This speeds up the design process and makes debugging more easier.

Which code set is used for HCC coding?

ICD-10-CM coding for HCC reporting is different from traditional ICD-10-CM coding because the intent is to report all conditions that affect the individual’s health status concurrently across the continuum of care.

When to use hierarchical condition categories ( HCC )?

An Introduction to Hierarchical Condition Categories (HCC) When coding and submitting claims for a physician’s professional services in a Fee for Service (FFS) world, claims data is used to determine whether a service meets medical necessity criteria and if so, how much money the payer will allow for the billed services.

When did CMS start using hierarchical condition categories?

As part of this effort, the Centers for Medicare and Medicaid Services (CMS) introduced the Hierarchical Condition Category (HCC) in 2003. HCC is a set of codes that CMS uses to determine reimbursements to Medicare Advantage plans.

How are hierarchical condition categories used in quality payment program?

The Quality Payment Program (QPP) introduces risk adjustment to physician payments via a method that has long been used for other purposes: The Hierarchical Condition Categories (HCC) first established in 2004. Examples of how the QPP will use HCCs in determining payment for professional services include:

Can a beneficiary have both HCC 86 and HCC 19?

A beneficiary can be assigned both HCC 86, Acute myocardial infarction, and HCC 19, Diabetes without complications, each of which would provide for risk adjustment. The CMS-HCC model incorporates other risk adjustments.

What are hierarchical condition categories? HCCs, or Hierarchical Condition Categories, are sets of medical codes that are linked to specific clinical diagnoses. Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions. What is the…