Medicare Advantage HCC model is changing

Upcoming revisions to the Medicare Advantage Hierarchical Condition Categories model will impact members’ risk scores.

The HCCs are being modified to reflect changes in ICD-9-CM codes that have occurred since the late 1990s, when the current HCCs were created. ICD-9-CM codes are the national standard coding language used to translate a patient’s clinical condition into three- to five-digit codes.

The Centers for Medicare & Medicaid Services announced the revisions on April 1, 2013, and changes will affect the 2014 payment year.

Features of the new model include:

• Major changes in several areas, including chronic kidney disease, diabetes, polyneuropathy, morbid obesity and neurological and metabolic disorders
• Diseases previously included in an HCC with other related conditions will have their own HCCs. These conditions include quadriplegia, cerebral palsy, amyotrophic lateral sclerosis and other motor neuron diseases, as well as atherosclerosis of the extremities with ulceration or gangrene.
• Seventy-nine HCCs — compared with 70 in the previous model
• It removes 129 ICD-9-CM codes that were in the previous model. These codes mapped to condition categories such as kidney disease, major complications of medical care, neurological diseases and cardio-respiratory failure and shock.

CMS is also introducing 224 new ICD-9-CM codes related to condition categories such as morbid obesity, lung disorders, hematological disorders and spinal cord disorders and injuries.

For more information about changes to the Medicare Advantage HCC model, visit hccublog.scanhealthplan.com/2013/04/risk-adjustment-changes-for-2014.html** or contact your Blue Cross Blue Shield of Michigan provider consultant or Blue Care Network provider representative.

**Blue Cross Blue Shield of Michigan doesn’t control this website or endorse its general content.