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HCC CODING & HEDIS ABSTRACTION

Medicare advantage plans offer more benefits to its members and they are partially funded by Center for Medicare and Medicaid Services (CMS).  Almost 30% of Medicare patients have now enrolled in Medicare advantage plans and many more to be in coming days. CMS make their payments based on the formula added with risk adjustment factors that covers all the members in the plan.

Hierarchical Condition categories coding (HCC) plays a vital role for Health plans to provide accurate payments. Medicare advantage plans must code the health status using HCC codes, which are based on diagnostic codes in the medical record to enhance the risk adjustment increase payments.

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