The RCxRules Blog

RCxRules HCC Coding Engine Updates for the V28 Transition

CMS implemented significant changes to the HCC model in V28 being rolled out in 2024. Why are these changes important? Because they will significantly impact RAF scores for a large percentage of Medicare Advantage patients. These changes include:

  • Increased the number of HCCs by 29
  • Changed the names and numbers of HCC codes
  • Changed ICD-10-CM code to HCC mappings
  • Changed the coefficient values
  • Removed 2,236 diagnosis codes that no longer map to a payment HCC
  • Added 209 diagnosis codes that did not previously map to a payment in V24

Proper HCC coding ensures accurate risk adjustment, which directly impacts Medicare Advantage payments. By capturing a comprehensive picture of each patient's health status, HCC coding V28 facilitates fair reimbursement for healthcare providers based on the complexity and severity of their patients' conditions.

Understanding the fundamental aspects of HCC coding V28 is essential for accurate implementation. To mitigate the potential financial impact of the new HCC model changes, medical practices and health plans should consider using technology that can assist with the transition. The RCxRules HCC Coding Engine has created a special product patch to help you handle this transition. This patch will enable the following capabilities:

  • RCxRules can simultaneously represent CMS V24, CMS V28, and a consolidated model with V24 diagnoses plus the 209 diagnoses that are added with CMS V28
  • Our charge entry will display the models you choose. Our default will display both the V24 and V28 descriptions.
  • Rules will run based on the model you choose. Our default rules will be configured to run against the consolidated model.
  • We have updated the RCx HCC database to add a new ‘display value’ field so it’s easier to tell the V24 HCC from a V28 HCC
  • RCx will deliver updated reports to be compatible with this new configuration

Thorough documentation and adherence to coding guidelines are critical for accurate HCC coding through the transition from V24 to V28. Healthcare providers should ensure that all relevant diagnoses and conditions are accurately documented in the patient's medical record to capture the full clinical picture. And HCC mappings are subject to an annual refresh, incorporating updates and revisions to reflect changes in medical knowledge and practice. Healthcare providers will have to stay up to date with the latest version to maintain coding accuracy and compliance. RCxRules always maintains current content in our HCC Engine, relieving that burden from your organization.

Set up a meeting to learn more about how the HCC Coding Engine can help you with the transition from V24 to V28.


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