Earlier this year, the Centers for Medicare and Medicaid Services (CMS) announced the final rule for the HCC Risk Adjustment Model for the payment year 2024. Now is the perfect time to ensure that your Medicare Advantage (MA) plan’s transition from Version 24 (V24) to Version 28 (V28) is on track for phasing in over the next three years.
The new model includes significant changes to Hierarchical Condition Category (HCC) codes and disease mapping. These changes will have a major impact on your plan’s ability to accurately calculate Risk Adjustment Factor (RAF) scores. Three steps your health plan can take to efficiently manage the HCC model transition so you can confidently estimate MA beneficiary healthcare costs include:
Audit HCC Mapping: The new model reflects major changes to HCC category and numbering schema.
Update ICD-10 Codes: More than 2,000 codes that currently map to reimbursement in V24 will no longer map to an HCC in V28.
Align Analytics and Technology Initiatives: Coordinating updates to RAF score models with data analytics platforms is essential.
For more information on best practices for assessing if your plan’s HCC data ingestion, curation and enrichment platform is best configured to create accurate, data-driven RAF scores, contact Health Chain.