HCC risk adjustment in 2025 is more than just a compliance checkbox – it’s a strategic driver of revenue and regulatory resilience. With the Centers for Medicare & Medicaid Services’ (CMS) hybrid model blending the 2020 and 2024 HCC frameworks, risk adjustment medical coders, compliance teams, and clinical leaders are navigating a landscape where outdated codes vanish, specificity is king, and audits loom large.
But with the right tools and techniques, this complexity becomes opportunity.
The healthcare revenue cycle is undergoing significant transformation, driven by evolving regulations, shifting payer policies, and increasing administrative burdens. For revenue cycle leaders, these changes present both challenges and opportunities, especially in optimizing medical billing accuracy and choosing a medical billing outsourcing company partner.
With the current administration promising more deregulation in
As the healthcare industry continues to shift toward value-based care, precise Hierarchical Condition Category (HCC) risk adjustment is more important than ever for organizations aiming to optimize reimbursements. The 2025 CMS risk model updates will demand enhanced precision, adaptability, and compliance. To thrive, healthcare organizations must prioritize accuracy
For revenue cycle leaders, maintaining compliance while minimizing financial risk is an ongoing challenge. As healthcare entities continue to see increasing risk from changes to government policies, shifting patient demographics, and shrinking margins, risk management will become an increasingly essential focus for survival. One of the most effective tools for achieving risk management goals is examining the application of Comprehensive Error Rate Testing (CERT) and how it impacts organizations that deal
Revenue cycle leaders face increasing pressure to manage costs, optimize revenue, and improve revenue cycle functions. This has included more responsibility in understanding the intersection between risk adjustment coding and social determinants of health (SDOH). This intersection is critical to ensuring accurate reimbursement and optimizing revenue cycle outcomes, especially for Medicare Advantage and Medicaid populations, where SDOH significantly influences health outcomes and
