The Centers for Medicare and Medicaid Services (CMS) has recently released its new Hierarchical Condition Category (HCC) model, version 28 (V28).
This new model will have a significant impact on health plans, as it drops certain HCC codes that were previously used to calculate risk scores.
Risk scores are a key factor in determining a health plan’s payment from CMS, and the dropped HCC codes will impact health plans differently depending on their member population.
Top 5 Disease Categories Impacted by HCC Model V28
These are the top 5 disease categories that are significantly impacted by the dropped risk scores in the new CMS HCC Model V28.
Disease Category | Percentage of Dropped HCC Codes |
Complications | 100% |
Kidney | 85.94% |
Amputation | 85.03% |
Metabolic | 69.16% |
Psychiatric | 49.25% |
Blood | 48.78% |
The new CMS HCC V28 model has dropped certain HCC codes, which will impact health plans differently depending on their member population. Those with a high percentage of members suffering from kidney disease, amputation, metabolic disorders, psychiatric conditions, or blood disorders will see a significant impact on their risk-adjusted revenue. In contrast, those with a low percentage of such conditions may not feel much of an impact.
Action Items and Next Steps
It’s crucial for health plans to evaluate how the dropped HCC codes will affect their member population and revenue. This assessment should include a review of current programs, identification of opportunities for adjustment, and seeking assistance from healthcare consulting teams. That’s why we want to help.
Action items:
- Conduct a thorough analysis of the member population to identify which HCC codes are most prevalent.
- Determine the potential impact of the updated model on risk-adjusted revenue and develop a mitigation plan if necessary.
- Monitor coding practices and ensure accurate capture of all relevant diagnoses.
- Explore strategies such as improving care coordination, disease management, or value-based payment models to manage the impact of the updated model.
V28 Impact Report for your Health Plan
Our team can help you in assessing the impact of these dropped codes on your member population and revenue. We’ll review your current programs and identify opportunities for adjustment to ensure that you continue to provide quality care to your members. Don’t risk a potential decrease in revenue by not taking proactive measures.
Contact us today to get started and confidently move forward. With proper strategies and resources, your health plan can adapt to the new changes in CMS HCC V28 model while continuing to provide high-quality care to their members.
