Checklist for the Annual HCC “Reset”


One unique aspect of HCC coding is that it requires provider documentation of HCC conditions each calendar year. As the holidays approach, we need to remember the annual HCC “reset” will be upon us January 1.

Now is the time to prepare for the New Year by compiling a list of active conditions that our 2019 Medicare Advantage patients have. Watch the appointment schedule during the first three months of 2020 and provide the list to the provider or his/her nurse as a prompt to review, assess, and document the patient’s status in that first 2020 visit encounter note.

Use this handy checklist to ensure often overlooked active conditions are documented during the first patient visit of the year:

  • Amputations,
  • Artificial Openings (Ostomies),
  • Asthma,
  • Pulmonary Disease (On Oxygen),
  • Chronic Skin Ulcer,
  • CHF,
  • Drug Dependent,
  • Metastatic Cancers,
  • Obesity,
  • Rheumatoid Arthritis, and
  • Specific Type of Major Depressive Disorder.

At the same time, help your providers refine their problem lists by identifying conditions that have been resolved and no longer are being treated. Encourage them to “delete” or “deactivate” them.

Why does the HCC reset matter? Beyond coding the principal and significant secondary diagnoses, coding all co-morbidities, regardless of how insignificant, that were addressed by the provider can supplement the profile of a member with additional HCCs that add to the overall risk adjustment factor which in turn impact the reimbursement rate.

Coders and Documentation Improvement Specialists can have a critical role in ensuring complete and accurate documentation of HCC conditions. If interested, consider in-depth HCC training to ensure your skills are prepared for the challenge.


Fundamentals of HCC Coding
Learn more from Rose! Go beyond just the diagnoses — really understand the methodology behind HCCs with the course “Fundamentals of HCC Coding.” Learn more here.


About the Author

Rose Dunn
Rose Dunn is the Chief Operating Officer at First Class Solutions, Inc., a healthcare information management leader since 1988. Rose is the author of “The Revenue Integrity Manager’s Guidebook” available from the National Association of Healthcare Revenue Integrity and other books on Coding Management and Auditing from HCPro. She engaged herself in ICD-10 more than 10 years before it was implemented. She is assisting Libman Education in the development of an HCC educational program. Rose holds a BS and MBA from Saint Louis University.

2 thoughts on “Checklist for the Annual HCC “Reset”

  1. Charlotte Barrett - November 13, 2019 at 4:24 pm

    Great resource from a well respected speaker and consultant,

    • Elavarasan - November 26, 2019 at 1:14 am

      I’m Elavarasan i hava 4 years experience in HCC at episource, I complicated CCS…