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HCC frameworks, risk adjustment medical coders, compliance teams, and clinical leaders are navigating a landscape where outdated codes vanish, specificity is king, and audits loom large.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 Centers for Medicare & Medicaid Services’ (CMS) CY 2026 Rate Announcement introduces significant updates that directly impact medical coding risk adjustment, revenue cycle operations, and overall reimbursement strategy. As healthcare leaders evaluate their prospective risk adjustment strategies in light of these changes, understanding the
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
After releasing new HCC coding guidelines, CMS has published the latest Medicare Advantage Rate announcements, sparking speculation around the impact on providers. These potential impacts include shifts in Medicare Advantage enrollment, questions around the effects of changing economic conditions, and increases in payments to Medicare Advantage plans. All of this is unfolding at a time when government spending is under increased criticism – Medicare Advantage plans are known to cost the
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
