HCC Coding 101: Understanding Basic Definitions

HCC Coding 101: Understanding Basic Definitions

It can be pretty difficult to adhere to CMS requirements for coding and reimbursement submissions. With so much to take into consideration and so many acronyms and terms to learn, do you feel your head spinning?

Want to learn more about HCC coding? Keep reading to learn more about the basic terms used in the industry.


HCC stands for Hierarchical Condition Category. This is a type of coding used for chronic disease medical coding and reimbursement. This type of coding was put into place in 2004 as a way to help adjust capitation payments for private health care plans.

Medicare Advantage Plans

Medicare Advantage Plans are healthcare plans that are offered by the private companies that contract with Medicare. These plans offer coverage for Part A and Part B.


CMS stands for the Centers for Medicare & Medicaid Services. It is part of the Department of Health and Human Services. The purpose of CMS is to protect the health and well-being of Americans. Their goal is to provide access to quality and affordable health care to more Americans.

Risk Adjustments

Risk adjustment identifies a patient’s disease and healthcare management needs and determines the reimbursement that is allotted by CMS. HCC Is a type of risk adjustment reimbursement.


This is an acronym that stands for mirror, evaluate, assess/address, and treat. This acronym is used to ensure the proper and accurate data is being recorded through HCC coding.

Need help with HCC Coding? Contact HCC Coders today!

When it comes to HCC coding, it is easy to get confused. There’s ICD-10 codes, ICD-9 codes, risk adjustment coding, CMS, HCC, and more. That’s not even including MEAT and Medicare Advantage Plans. It’s easy to become overwhelmed with HCC Coding, but thankfully, HCC Coders is here to help! That’s right, since 1993, we’ve been providing quality HCC coding services and we would be happy to do the same for you. Whether you need us to review and audit past work or want our coders to take over the process completely, we’re here to provide customized solutions for our clients. Contact us today at 877-328-2343 to learn more or request a quote for our reliable and affordable HCC coding services.

To learn more about the reliable and quality HCC coding services that we offer, visit us on the web at HCC Coding.