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.
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eLearning Library: HCC/Risk Adjustment offers the resources you need to ensure accurate and complete capture of Hierarchical Condition Categories (HCCs) codes, supported by documentation, for appropriate reimbursement. Includes specific training materials recommended for Certified Risk Adjustment Coder (CRC)® certification exam preparation. Over 70 AHIMA and AAPC CEUs. On-demand access to up-to-date course materials enhances job-specific, self-paced learning for one full year. -
Go beyond just the diagnoses -- really understand the methodology behind Hierarchical Condition Categories! Prepare for the future of healthcare reimbursement with HCC: Essentials of Hierarchical Condition Categories Coding, by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE. -
HCC: Quick Reference Guide is a useful tool to communicate quickly and clearly to your providers the essential documentation necessary to support HCC diagnoses. Delivered as a downloadable and printable .pdf, the HCC: Quick Reference Guide features straightforward instruction for providers in 16 specialties. -
Internal HCC auditors ensure their organization receives the reimbursement they are entitled to and that codes and claims are supported by clinical documentation. Learn what to look for and how to communicate your findings. Tips and techniques offered by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE. -
HCC: Claims and Reimbursement for Medicare Advantage provides comprehensive instruction on the unique and challenging aspects of the claims process used in Medicare Advantage Organizations. Course by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE. - HCC: Compliance provides the essential knowledge you need to implement an effective compliance program for your organization to monitor the accuracy of HCC diagnosis codes. Course by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE.
- HCC: Documentation provides guidance on ensuring documentation is complete and adequate to support HCC diagnoses. Course by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE.
- HCC: RADV Changes, Findings and Appeals provides essential guidance on the Risk Adjustment Data Validation (RADV) process and how to ensure your organization is prepared for audits and able to respond appropriately. Course by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE.
- HCC: RADV, CMS, and HHS-HCC Audits provides an orientation to Risk Adjustment Data Validation (RADV) audits for CMS and HHS HCC code assignment. Course by nationally recognized HCC authority Rose T. Dunn, MBA, RHIA, CPA, FACHE.
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Are your problem lists a problem? Providers have enough documentation burdens already. Problem lists, when up-to-date and accurate, can help facilitate patient safety and care and are a key aspect of some risk adjustment contracts. HIM and CDI specialists have a role to play. - Author Rose Dunn, MBA, RHIA, CPA, FACHE, a nationally recognized authority in HCC and risk adjustment coding methodologies, explores the intent and purpose of various Medicare quality programs focusing on the importance of accurate, "by-the-book," complete, and defensible coding and documentation.
- Sale! Join nationally recognized HCC Coding Authority, Rose T. Dunn, MBA, RHIA, CPA, FACHE for this introduction to the principles and concepts of Risk Adjustment Coding including the significant changes resulting from the transition to the Version 28 CMS HCCs.
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Skills Assessment: HCC measures competency in the Hierarchical Condition Categories (HCC) risk adjustment reimbursement methodology and understanding of critical concepts. There are no coding questions. Libman Education skills assessments are fully up-to-date and measure the critical skills employers are looking for.