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HCC V24 to V28- Making the Transition


Schedule


Presenter(s):

Jan Hailey

Location:

Webinar US

Date:

11/12/2024

Time:

12:00pm - 1:00pm
CENTRAL TIME

Price:

$119.00

CEUs: 1

 

Can't attend? Register anyway and you'll receive a link to the recording by the next business day.


About this program


Back by Popular Demand. Rebroadcast of a PMI favorite.

The Centers for Medicare and Medicaid Services (CMS) uses Hierarchical Condition Category (HCC) risk adjustment models to estimate future healthcare costs for Medicare Advantage patients based on health status and demographic factors. The Risk Adjustment Factor (RAF) score determines the amount paid by CMS to the health plan per patient. Medicare Advantage Organizations (MAOs) are paid at a higher rate for patients who have multiple conditions and conditions with greater levels of severity, as their RAF scores and anticipated costs of care will be higher. CMS finalized revisions for the Part C risk adjustment model for 2024 that incorporate recalibration and clinical reclassification of HCCs.

The CMS-HCC model V28 is being phased in over a three-year period, with V24 fully phased out for 2025 dates of service. In addition to improving payment accuracy, the updated model is expected to reduce coding differences between Medicare Advantage plans and fee-for-service Medicare providers.

This transition from Version 24 to Version 28 represents a significant change in the risk adjustment model used in the Medicare Advantage reimbursement system. V28 includes over 200 additional new codes, while over 2,000 will be removed. Providers must carefully manage this three-year transition period and adapting to the challenges posed by managing two model versions. Plus, the changes in risk scores and HCC codes may have a financial impact on healthcare providers. Providers should be identifying the top HCCs among their patient population to understand the potential impact and embrace clinical specificity in their documentation.

Highlights:

  • New hierarchical names/numbers
  • Changes to ICD-10 code to HCC mappings
  • HCC coefficient values differences
  • Codes that did not map to payment in V24
  • Strategies for success during the transition