Hierarchical Condition Categories

Hierarchical condition categories. Applied to predicting the cost of high-risk patients.

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What exactly are hierarchical condition categories (HCCs)?

HCCs are captured over the span of a year by documenting the highest disease categories for a patient’s conditions. HCC data is also used to calculate risk- adjustment factor (RAF) scores across the continuum of care. Both HCCs and RAF scores ultimately determine how accurate reimbursement is in the world of value-based care.

Successfully managing HCCs requires the understanding and practice of complete documentation and coding. Does your current documentation reflect accurate risk scores for your patient population?


HCC solutions from 3M

3M experts can provide a comprehensive assessment of your current HCC state. Through data analysis and medical record review, this assessment may help you identify specific areas to improve HCC capture and revenue opportunities. 3M consultants also offer HCC education for physicians and CDI/ coding staff.

  • Where are HCCs used?

    • Medicare Advantage plans
    • Medicare shared savings ACO (expected cost)
    • Value-based purchasing (expected cost / efficiency)
    • Some commercial ACOs / Shared Risk arrangements
    • Health insurance exchange plans
    • Population health/risk stratification/cost prediction
  • Top HCCs challenges

  • Want to learn more about 3M’s HCC solutions? Fill out this form and we’ll get in touch.

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