Medicare payments require HCC system

The Centers for Medicare & Medicaid Services (CMS) — the federal agency that oversees Medicare — now pays all Medicare Advantage and Prescription Drug Plans exclusively through the Hierarchical Condition Category (HCC) model. Previously, CMS relied solely on demographic information for payments.

The HCC assigns a code indicating the level of “risk” for each member. CMS will pay the most to treat the members who are the most sick, i.e., those with the highest risk-adjustment scores.  

The HCC model relies on the ICD-9-CM system of codes. Under this system a provider must:

• Put the patient’s name on each page of the medical record
• Sign and date each entry
• Update the problem list after each visit
• Record all diagnoses made as a result of face-to-face visits
• Keep all documentation clear, concise, complete, and legible