Comparison of HCC Coding: Types – ACA & MA
Hierarchical Condition Category (HCC) coding is a risk-adjustment model used to predict healthcare costs based on patient diagnoses. It is widely used for reimbursement and risk adjustment in value-based care models. Two Major Types of HCC Coding: ACA HCC (Affordable Care Act HCCs) Used for commercial insurance plans under the Affordable Care Act (ACA) risk adjustment model . Applies to individual and small-group marketplace plans. Helps adjust payments to health plans based on the health risk of enrollees. Uses a different HCC model than Medicare Advantage, focusing on broader populations. MA HCC (Medicare Advantage HCCs) Used for Medicare Advantage (MA) plans to determine capitated payments from CMS (Centers for Medicare & Medicaid Services). Focuses on elderly and disabled populations enrolled in Medicare Advantage. Uses a risk adjustment model to ensure appropriate reimbursement based on chronic conditions. More focused on chronic diseases commonly found in senior populatio...