These models use patient information, including demographic characteristics like age and gender, along with health status data based on ICD-10-CM diagnosis codes, to predict future healthcare costs. For instance, the CMS-HCC model uses data from a base year to forecast expenses for the following year, while the HHS-HCC model predicts costs based on current health events.

At HealthIQ Solutions, our skilled HCC coders meticulously validate medical record eligibility and accurately assign ICD-10 CM codes when conditions meet TAMPER (Treatment, Assessment, Monitor/Medicate, Plan, Evaluate, Referral) or MEAT (Monitor, Evaluate, Assessment, Treatment) criteria. We also identify missed RAF scoring opportunities and address under-documentation issues through a robust CDI program, ensuring comprehensive and accurate risk adjustment for your healthcare organization.