HCC V28: How to Prepare

Introduction

By 2025, the transition from HCC V24 to V28 will be complete. CMS has already begun a phased transition to the new model, but as we move into Q3, time is running out to prepare for 100% adoption. So what can organizations do to be ready for HCC V28? How can they remain compliant, ensure they’re correctly reimbursed, and that they continue to deliver exceptional patient outcomes under the new model? This short guide explains the essential next steps.

 

STEP 1: Understand the changes

Preparing for HCC V28 means teams must first understand the changes, and how they will affect their organizations. The following is a brief overview of the major differences between V24 and V28, but ongoing HCC coding education is critical if clinical and non-clinical staff are to understand their responsibilities in the new model.

 

  • Demographic rates. Demographic factors including sex, age, disability status and dual eligibility status are weighted differently in HCC V28. In the new model, average rates will significantly decrease across most categories.
  • HCC numbers. The total number of HCCs has increased in V28 – from 86 in V24 to 115 in the new model – while the total number of codes has fallen from 9,797 to 7,770.
  • HCC groupings. CMS divides HCCs into 26 different condition ‘groupings’, and these groupings have changed significantly in V28. HCCs are coded, grouped and assigned differently – and staff will have to familiarize themselves with those changes.
  • RAF modifiers. RAF modifiers including the Disease Interaction modifier and the Payment HCC Count modifier have also undergone changes between V24 and V28. The majority of interaction categories have seen their values reduced in the new model – with a couple of notable exceptions – while most Payment HCC Count modifiers have increased.
  • Raw RAF adjustments. CMS’ backend RAF adjustment (the Normalization Factor) has been reduced in HCC V28, adjusting from 1.127 to 1.045.

 

This is just a topline summary of the changes between V24 and V28. For a deeper dive, check out our four-part series: Transitioning to HCC V28.

 

STEP 2: Assess reimbursement amounts 

The aforementioned changes will affect how each patient’s RAF score is calculated, and consequently, the amount organizations can expect to be reimbursed for their care. 

 

In HCC V28, RAF scores are likely to be a little lower than in the previous model – except for patients with multiple HCCs. However, every patient is different, and of course a number of factors influence how their RAF scores are calculated. 

 

While organizations can expect to receive slightly lower reimbursement amounts in V28, this won’t necessarily be true in every case. Medicare Advantage Organizations should calculate each patients’ adjusted RAF value to accurately determine reimbursement in the new model, and allow for reliable financial planning.

Sign up to our DoctusTech VBC Hub to receive tailored content recommendations direct to your inbox.

Sign up to our DoctusTech VBC Hub to receive tailored content recommendations direct to your inbox.

 

STEP 3: Ensure documentation accuracy

In HCC V28, many established HCC groupings, codes, and diagnoses have changed. New codes have been added, many old codes have been removed, and others have been combined or reclassified. In short, there’s a lot for clinical and non-clinical staff to re-learn. 

 

Maintaining documentation accuracy with a new set of rules and variables will prove a significant challenge for many organizations. Here are two approaches to maintain and improve documentation accuracy in HCC V28:

Continuous training and education

It’s widely accepted that HCC coding education is important to bring clinical and non-clinical staff up to speed with the documentation requirements of the CMS risk-adjustment model. However, traditional training methods result in knowledge retention rates of just 30% or less. With the new model taking effect, staff require continuous HCC coding education via a method that both engages them, and ensures lasting knowledge retention.

 

DoctusTech uses app-based learning to engage clinicians at 90%, with clinical vignettes and weekly questions offering up to 75% knowledge retention. Our app is up-to-date with HCC V28, and we even offer dedicated programs to help staff get to grips with the new model

Automated chart review

Automation can make it easier for clinicians to capture more accurate HCCs at the point of care. DoctusTech’s fully-integrated EMR workflow solution is an easier way for clinicians to accurately document HCCs on every patient, in their EMR of choice. Artificial intelligence allows us to automate the chart review process – helping clinicians translate patient charts into accurate HCCs in seconds.

 

If you’re concerned about the transition to HCC V28 and want to ensure continued compliance and documentation accuracy, DoctusTech can help. Schedule a demo today and find out how we can help your team prepare for V28.

Leave a Reply

Your email address will not be published. Required fields are marked *