Hierarchical Condition Category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. HCC coding helps communicate patient complexity and paint a picture of the whole patient. In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics. By accounting for differences in patient complexity, quality and cost performance can be more appropriately measured.
CMS uses two models: The first, CMS-HCC is the model used to pay Medicare Advantage Organizations. The second model was developed after the passage of the Affordable Care Act to pay health insurers in the ACA marketplace. ReviewMate currently has a CMS-HCC module and an HHS-HCC module under construction.
ReviewMate pushes important metrics like performance targets and averages to keep you proactive on audits. ReviewMate has multiple options for controlling HCC audits.