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Tip: CDI specialists should learn how HCCs work
The concept of Hierarchical Condition Categories (HCC) is not new; CMS implemented the HCC model in 2004 as a way to determine capitated payments for Medicare Advantage plans. With the number of patients enrolled in Medicare Advantage tripling in size since 2004 and the expansion of HCC models to Part D plans (under the CMS-RxHCC model) and commercial payers (under the HHS-HCC model), though, improving documentation to appropriately capture HCC-related conditions needs to be on radar not only for those seeking to expand review targets into the outpatient arena but also for those working in traditional inpatient care settings.
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