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MEDTECH The CMS is moving from HCC Version 24 to Version 28, impacting reimbursements for practices across the nation.
The Centers for Medicare and Medicaid Services (CMS) is transitioning from HCC Version 24 to Version 28, effective January 1, 2024. This change will not only alter the reimbursement landscape but also risk the income of oncology practices. The shift has immediate consequences, as it partially comes into effect in the current RAF calculations. Healthcare providers must pay close attention to the revised model to prepare adequately for these sweeping changes.
HCN Medical Memo
Oncology practices should view the transition to HCC Version 28 as a pressing issue. A clear understanding of the changes can make the difference between maintaining current income levels or facing drastic reductions in reimbursements. Practices should mobilize their coding and billing teams and may also need to consult with experts to navigate this complex transition smoothly. Failing to prepare now could lead to financial challenges that will be hard to0 overcome later.
Key Points
- The CMS is moving from HCC Version 24 to Version 28, impacting reimbursements for practices across the nation.
- The transition begins on January 1, 2024, and will roll out over three years.
- Version 28 is already partially in effect, with current RAF calculations being a blend of 33% Version 28 and 66% Version 24.
- About 2,300 ICD-10-CM codes will be eliminated, affecting the mapping of numerous codes that oncologists commonly report for demonstrating a patient’s complexity.
“Through this change, CMS is looking to save almost $11 million in the Medicare fund.”
– Amy C. Pritchett, manager of HCC Coding/Audit & Education Services with Pinnacle Enterprise Risk Consulting Services
Additional Points
- Some practices are unaware of the immediate impact of the transition and are not adequately prepared.
- Oncology staff members are generally not well-versed in HCC coding changes, making external consultation from experts crucial.
- Failure to adapt to these changes may result in financially catastrophic scenarios for oncology practices, including a significant drop in shared savings.
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