“In the past few years, the role of Hierarchical Condition Categories, or HCCs, in payer reimbursement has done nothing but intensify. Health care in recent years has made a huge push in the direction of quality over quantity. What this ultimately means is that HCCs are not going away anytime soon.”

In 2018, our blog article “Exploring the Basics – HCCs for Beginners” gave us a basic outline of what we could expect regarding the importance of HCCs. Like quoted above, our experience since 2018 is that the HCCs have intensified and they have not gone away. In fact, we are in the thick of the “HCC Sweep Season”, where facilities correspond the submission of HCC coding with the timeline that Medicare allows for specific reimbursements to be submitted. Sweep season for HCC Coding is prioritized from May to December each year. Even though we are in the middle of the high demand HCC coding season, there is still a high demand for certified HCC coders. We want to answer 3 questions regarding HCC coders and why they, and their certifications, are important:


For clarification, what is HCC coding?

Definition provided by the AAFP:

“Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004, but is becoming increasingly prevalent as the environment shifts to value-based payment models.

Hierarchical condition category relies on ICD-10 coding to assign risk scores to patients. Each HCC is mapped to an ICD-10 code. Along with demographic factors (such as age and gender), insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurances can use a patient’s RAF score to predict costs. For example, a patient with few serious health conditions could be expected to have average medical costs for a given time. However, a patient with multiple chronic conditions would be expected to have higher health care utilization and costs.”

See more here: https://www.aafp.org/practice-management/payment/coding/hcc.html



Why is HCC Coding needed?

There is an added complexity to HCC coding that involves a RAF (risk adjustment factor) score. The utilization of the RAF score helps determine future Medicare payout, as risk adjustment quality metrics and cost metrics are taken into consideration. These considerations will ultimately impact the payout amounts associated with the future of HCC coding. In the link listed above, the AAFP gives us a great comparison of two sample patients where the RAF score is taken into consideration to determine the overall optimized risk of a patient that has a hierarchical condition.




Why coders should consider certifying in HCC?

CRC Certification – or Certified Risk Adjustment Coder Certification – is a certification process that takes the importance of medical chart coding (ICD-10) and includes RAF score consideration and risk adjustment models. Coders being trained to understand the accuracy and importance of following risk adjustment models are valuable, in that those reflections can determine the future cost of patient’s healthcare needs.

As an added benefit, according to the AAPC (a provider of the CRC certification), records indicate that CRCs that are trained in HCC Coding have a history of earning 40% more than non-credentialed CRC coders.

More information on CRC Certification and becoming and HCC coder can be found here:



As of today, TrustHCS is looking to hire experienced HCC coders during the 2020 sweep season. If you have the CRC Certification, are interested in HCC Coding, and joining the TrustHCS team, do not hesitate to  apply at https://trusthcs.com/careers. We look forward to hearing from you!