BC Advantage - 2023 Issue 11
Capturing HCCs in a Changing World
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Article Overview
This article explains broad changes affecting Medicare Advantage risk adjustment and HCC capture during the transition to a newer CMS model. It is aimed at coding, auditing, risk adjustment, and population health stakeholders who need to understand the timing of the change, the kinds of diagnosis-code and HCC-category updates involved, and the general documentation and analytics work needed to prepare for revised payment calculations.
Why This Topic Matters
Risk adjustment model changes can alter how chronic conditions are reflected in payment and shared savings calculations. The article helps organizations understand why updated coding capture, documentation review, and data analysis matter during a multi-year transition.
What You Will Learn
- How CMS’s Medicare Advantage risk adjustment model transition affects HCC capture
- What types of model changes and diagnosis-code updates are occurring
- Why documentation review and population-level analysis are important during the transition
- How organizations can broadly prepare for revised risk adjustment calculations
Who Should Read This
- Medical coders
- Risk adjustment staff
- Auditors
- Compliance teams
- ACO administrators
- Population health teams
- Physician documentation reviewers
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