Diagnosis Coding
This is the ICD-10 code(S) reported for a patient diagnosed with Hypertension and heart failure
I11.0, I50.9
This model is also known as Commercial, Individual, and Small group.
HHS-HCC (Health & Human Services Hierarchial Condition Category)
The number of star rankings in the CMS Star Ratings Program
5 STARS= EXCELLENT PERFORMANCE
Every medical record must have this in order to be valid and it is considered the utmost important
Provider's signature
This is the ICD-10 code(S) reported for a patient diagnosed with Diabetes and CKD (Chronic Kidney Disease Stage 4)
E11.22, N18.4
This model is for the Medicaid payment system.
CDPS (MEDICAID CHRONIC ILLNESS & DISABILITY Payment Systems)
This star rating would be for a health plan with a below average performance
2 Stars
CMS requires the treating provider to sign this in a timely basis
Medical Record
(can vary from 30,60,90, or even 365)
This ICD-10 code(s) is reported for a patient diagnosed with ESRD (End Stage Renal Disease) and on dialysis.
N18.6, Z99. 2
This model is known in Medicare Advantage plans
Medicare Part C (Medicare HCC-C)
HEDIS
Healthcare Effectiveness Data & Information Set
Adding a missing signature or credential later
ADDENDUM
(VARIES BY ORGANIZATION)
This is the ICD-10 code(s) reported for a patient diagnosed with CHF (Congestive Heart Failure) combined diastolic and systolic.
I50.42
This model would be applicable to HCCs found in an inpatient setting.
Diagnosis Related Groups (DRG)
Name of the organization who creates the surveys for HEDIS
NCQA (National Committee for Quality Assurance)
RADV AUDIT
Risk Adjustment Data Validation
This is the ICD-10 code reported for a patient diagnosed with COPD (Chronic Obstructive Pulmonary Disease) with an acute lower respiratory infection.
J44.0, J22
This risk adjustment payment model would be applicable to HCCs captured in an outpatient setting.
Adjusted Clinical Groups (ACG)
Group of clinicians who have voluntarily come together in an organized way to deliver coordinated high-quality care to Medicare patients
APM (ALERNATE PAYMENT MODEL)
The official source for guidance for proper ICD-10 selection.
AHA Coding Clinic