Getting Paid: Prepare for HCCs and new emphasis on diagnosis codes from ACA plans

Why This Topic Matters

Risk-adjusted payment models place greater emphasis on diagnosis capture and supporting documentation, which can affect reimbursement, audit exposure, and practice workflow.

Article Sections

1. HCCs selected based on diagnosis coding

   This section introduces hierarchical condition classifications and explains their relationship to diagnosis-based risk adjustment. It also describes the general connection between patient condition severity, annual assessment, and payment models.

2. More audit requests in your future

   This section discusses expected changes for ACA exchange plans, including increased audit attention and documentation focus. It also notes the role of diagnosis specificity and references official resources.

3. Examples of common hierarchical condition categories (HCCs)

   This section presents example HCC groupings with associated diagnosis code lists and factor information. It is framed as a reference table supporting the article's discussion of risk adjustment.