Basic Definitions To Understanding HCC Coding

Basic Definitions To Understanding HCC Coding

HCC coding can be a challenge to comply with various CMS requirements for coding and submissions. Knowing how to accurately and efficiently code can significantly impact your bottom line. Let the experienced coders at HCC Coders help you today! One way HCC Coders can help is by simply reviewing some core basic definitions to help you better understand HCC coding.


HCC stands for Hierarchical Condition Category Coding mainly used for chronic disease coding and reimbursement. HCC was implemented in 2004 by CMS to assist in adjusting capitation payments for private health care plans – specifically Medicare Advantage plans. CMS adjusts payments based on demographic information and patient health status.


CMS is the Centers for Medicare & Medicaid Services and is part of the Department of Health and Human Services. The purpose of CMS programs has always been to protect the health and well-being of American families and improve the economic securities of the nation. Through the years, CMS have established additional services to allow more Americans to access quality and affordable health care.

Medicare Advantage Plans

Medicare Advantage Plans are a type of health care plans offered by private companies with contracts with Medicare. These plans provide coverage of Part A and Part B.

Capitation Payments

Capitation payments are payments that are agreed upon in a contract by a health insurance company and a medical provider. These are fixed, pre-arranged amount of payment received by a health care provider, clinic, or hospital per patient enrolled in a health plan.

Risk Adjustments

HCC is a type of risk adjustment reimbursement model, which adjusts for the risk and illness severity of patients. The risk adjustment identifies patients’ disease management needs and establishes the reimbursement allotted by CMS for the patient’s care. The risk assessment data used is based on the diagnosis from medical records and claims collected by physician offices, hospital visits, and outpatient clinic settings.


MEAT is an acronym used to ensure the most accurate and complete clinical information is being documented in HCC. MEAT stands for monitor, evaluate, assess or address, and treat. Monitor involves the signs and symptoms or disease process of a diagnosis. Evaluate captures the test results, medications used, and patient responses to treatment. Assess or address includes tests ordered, patient education, reviewing of records, and the counseling of patient and family members. Treat also involves the medications and therapies the patient receives along with the procedures and treatment modality used.

HCC Coder

A HCC coder is an individual knowledgeable in HCC coding and the process CMS uses with their reimbursement process. HCC coders must be up to date on best practices and educated on HCC coding regulations. Experienced HCC coders will report accurate medical diagnosis codes and clinical documentation. HCC coders must ensure that MEAT is met and validate with proper documented clinical information. The patient health status must be considered and the treatment and level of care has to be justified with proper documentation and correctly coded.

Our knowledgeable coders at HCC Coders can help you with all your coding needs. Don’t delay; contact us at 877-328-2343 today!