Wiki CMS Mappings

[mkalenkoski@pennstatehealth.psu.edu]

Could someone please provide some guidance as to how to read the CMS HCC mappings? I want to make sure I am interpreting it correctly. I was previously taught that if there was a number in the first four columns, then that category was an HCC. I am not sure if this is correct though. Here is an example of how I was interpreting the mappings... thank you in advance for any guidance you can give.

 

[sls314]

Could someone please provide some guidance as to how to read the CMS HCC mappings? I want to make sure I am interpreting it correctly. I was previously taught that if there was a number in the first four columns, then that category was an HCC. I am not sure if this is correct though. Here is an example of how I was interpreting the mappings... thank you in advance for any guidance you can give. View attachment 6243

Are you working for a provider and just want to make sure that you're accurately capturing all HCCs on your provider's current claims? Or are you working in risk adjustment data validation on a specific project for a vendor?

If you're working in risk adjustment, then your project guidelines should tell you which column to use. (Most likely you'd use either the Version 22 or Version 24 column, depending on which calendar year DOS you are auditing, but refer to your project guidelines to be certain.)

 

[mkalenkoski@pennstatehealth.psu.edu]

Thank you so much for your reply. I am working to ensure that I capture all of the HCC's on my provider's claims. My colleagues and I are unsure as to correctly interpret the mappings.