Understanding Hierarchical Condition Category Management for MAPs

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An Emerging Management Trend for Medicare Advantage Plans [MAPs]

By Dr. David Edward Marcinko; MBA, CMP™


So called Hierarchical Condition Category Management (HCCM) is an emerging healthcare management trend designed to accurately reflect the health status of Medicare Advantage Plan [MAP] members and to help them remain financially viable in Part D of the system.

HCCM Indications

Since the Medicare risk adjustment payment system uses clinical coding information to calculate risk premiums for Medicare Managed Care Organizations (MMCOs), HCCM seems best to address the following:

  • CMS risk adjustment system.
  • Strategic and financial implications for Medicare plans.


Any initiatives required to effectively managed care under a risk adjustment payment system is ripe for HCCM and the key success factors associated with these initiatives.

Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936901/


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2 Responses

  1. MAPs in 2012

    Click to access medicare.pdf

    Ann Miller RN MHA


  2. Hierarchical Conditions

    Keep hierarchical condition categories in mind when you code.


    Dr. David Marcinko MBA


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