HCC Blog by Caridad

On the CMS web page, there is a list of   Medicare Risk Adjustment Eligible CPT/HCPCS Codes Here is the link to download those:  https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/CPT-HCPCS Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

  The Office of Inspector General's (OIG) work plan is posted at this link.  In the gray area, on the left, there is a  "What's New" box. At the bottom there is a link for "Recently completed and published reports". This shows you what they posted each month to date. I look for the ones that start with "Medicare Advantage Compliant Audits..." as those detail their audits of HCC codes for the MA organizations. Also on this page, under the title "Work Plan" there are links for 'Recently Added', "Active Work Plan Items', "Work Plan Archive'. Click on those for more information.  https://oig.hhs.gov/reports-and-publications/workplan/index.asp Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, reg...

Charlson comorbidity The Charlson comorbidity index predicts the one-year mortality for a patient who may have a range of comorbid conditions, such as heart disease , AIDS, or cancer (a total of 22 conditions). Each condition is assigned a score of 1, 2, 3, or 6, depending on the risk of dying associated with each one. http://mchp-appserv.cpe.umanitoba.ca/concept/Charlson%20Comorbidities%20-%20Coding%20Algorithms%20for%20ICD-9-CM%20and%20ICD-10.pdf There are also online calculators that the provider can consider are available at the Medical Agorithms site.  The updated Charlson Comorbidities Index is found at Medical Algorithms site:   https://www.medicalalgorithms.com/charlson-comorbidity-index Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or l...

 I came across this Summary Information on the 2019 Benefit Year HHS Risk Adjustment Data Validation Results, released February 25, 2022.  https://www.cms.gov/files/document/2019-radv-results-memoclean2022-02-23.pdf Page two mentions the  Super Hierarchical Condition Category (Super HCC) group See the 2020 HHS-RADV Amendments Rule, 85 FR at 76984 - 76990 Scrolling down to page 10 of the document, we find  Appendix D: 2019 Benefit Year HHS-RADV Failure Rate Group Definitions.  Here the Super HCC and HCC categories are shown along side the Failure Rate Group (low, medium and high) Amendments to this document include: Amendments to the HHS-Operated Risk Adjustment Data Validation (HHS-RADV) Under the Patient Protection and Affordable Care Act's HHS-Operated Risk Adjustment Program Along side this document there is  https://www.federalregister.gov/documents/2020/12/01/2020-26338/amendments-to-the-hhs-operated-risk-adjustment-data-validation-hhs-radv-und...

 The Acceptable Physician Specialty Types for PY 2022 risk adjustment are found at the link below. Be sure to download the document for easy reference. https://www.csscoperations.com/internet/csscw3.nsf/DIDC/HSEK7AHN1H~Encounter%20and%20Risk%20Adjustment%20Program%20(Part%20C)~References    Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.