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
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Jan Hailey
MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
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Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.
Participants will learn of the changes in risk scores and HCC codes that may have a financial impact on healthcare providers with the transition from V24 to V28.
No prerequisites required.
Self-paced online program includes unlimited review of previously recorded instruction and the downloadable PowerPoint handout for 6 months.
Comments from past participants:
"Very informative and engaging."
"Lots of helpful information and reminders."
"Excellent presentation. I learned new information and strategies for success."
Prod ID: 479