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What Is HCC Diagnosis?


Hepatocellular carcinoma (HCC) is a primary tumor of the liver that usually develops in the setting of chronic liver disease, particularly in patients with cirrhosis due to alcohol use, chronic hepatitis B or C virus infections, or nonalcohol-associated steatohepatitis (NASH) [1,2].

What does HCC mean in healthcare?

Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997.

What does HCC stand for?

HCCs, or Hierarchical Condition Categories, are sets of medical codes that are linked to specific clinical diagnoses. Since 2004, HCCs have been used by the Centers for Medicare and Medicaid Services (CMS) as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions.

What is HCC risk score?

The CMS-HCC risk score for a beneficiary is the sum of the score or weight attributed to each of the demographic factors and HCCs within the model. The CMS-HCC model is normalized to 1.0. Beneficiaries would be considered relatively healthy, and therefore less costly, with a risk score less than 1.0.

How do you confirm HCC?

Tests and procedures used to diagnose hepatocellular carcinoma include:

  1. Blood tests to measure liver function.
  2. Imaging tests, such as CT and MRI.
  3. Liver biopsy, in some cases, to remove a sample of liver tissue for laboratory testing.

How does HCC develop?

This serious disease happens when liver cells are damaged and replaced with scar tissue. Many things can cause it: hepatitis B or C infection, alcohol drinking, certain drugs, and too much iron stored in the liver.

Is HCC curable?

Most people who develop HCC have cirrhosis, which is a build-up of scar tissue due to years of liver damage. Since HCC usually grows slowly in its early stages, it can often be cured if discovered early enough.

What are HCC gaps?

HAP has a Hierarchical Condition Category, or HCC, gap closure program. An HCC is a group of diagnoses used by CMS in their risk adjusted reimbursement model for Medicare Advantage plans. These codes are the primary indicators of a member’s health status. Most HCCs are conditions that tend to be chronic in nature.


What is dementia type HCC?

Starting Jan. 1, 2020, CMS will incorporate into its risk score calculation for MA plans an alternative payment condition model that includes additional Hierarchical Condition Category (HCC) codes for dementia: HCC51 — Dementia With Complications and HCC52 — Dementia Without Complications.

How many HCC models are there?

There are two different models for Hierarchical Condition Category (HCC) risk adjustments. The U.S. Department of Health and Human Services (HHS) oversees the HHS-HCC risk adjustment model 2020, which covers commercial payers of all ages and determines risk payments for the current year.

Which Hepatitis is associated with hepatocellular carcinoma?

Hepatocellular carcinoma (HCC) is the most common form of liver cancer; most cases of HCC (approximately 80%) are associated with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections.

What does HCC stand for in school?

An Introduction to Hierarchical Condition Categories (HCC)

What is the purpose of HCC coding?

Why is HCC coding important? Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics.

What is the difference between HCC and RAF?

HCC codes are additive, and some have multipliers. Population complexity/severity affects payment in many Medicare contracts. RAF is used for benchmarking for quality and safety. RAF enables identification and stratification for patient management.

What are the risk adjustment models?

Risk adjustment models were created in the 90’s by academia and funded by CMS as a method to adjust capitated payments to Medicare and Medicaid HMOs. The models are designed to predict future expenditures of enrollees based on diagnosis codes reported on claims and encounters.

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