“The Centers for Medicare & Medicaid Services (CMS) developed Hierarchical Condition Categories (HCCs) to adjust capitated payments for its Medicare Advantage (Part C) plans based on individualized patient risk. The health status of each patient is determined by their diagnoses, which are primarily based on International Statistical Classification of Diseases codes (ICD-10 codes) retrieved from claims data. The HCC risk adjustment methodology is used by all commercial Medicare Advantage plans as well as in the Exchange market. Thus, they are of utmost importance to any health plan or health system providing coverage.
But could the medical laboratory play a role in this process? If so, what?
Rhodes Group is synonymous with finding new values for medical laboratories through its FOCUS product line. Join us for our most recent developments in our newest application that uses laboratory results to assist in the area of risk adjustment!”