Risk adjustment is a methodology used to estimate the expected cost of treating a patient in a given year, based on their specific health needs. The Centers for Medicare & Medicaid Services (CMS) uses a specific risk adjustment model, the Hierarchical Condition Category (HCC) model, to calculate risk scores for Medicare Advantage (MA) beneficiaries. As of May 2025, more than 35 million people were enrolled in MA plans.
Individuals with in-depth knowledge and command of the HCC system ensure coding is accurate, supported by documentation, and that reimbursement is appropriate.
Hear from thought-leaders on the accelerating move toward risk adjustment payment models! Read our whitepaper HCCs and Coding for Value: A Virtual Roundtable.
View complete Libman Education course catalog >
