CMS Guidelines on HCC Coding, Auditing and Regulatory Requirements

Victoria M. Hernandez

Victoria M. Hernandez

Victoria is an RHIA (Registered Health Information Administrator), a Clinical Documentation Improvement Practitioner (CDIP), Certified Coding Specialist (CCS), a Certified Coding Specialist Physician-Based (CCS-P) and an AHIMA-Approved ICD-10-CM/PCS Trainer with over 25 years of experience in the healthcare field. Victoria is the Founder of a...
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Pre-recorded
60 Mins
Victoria M. Hernandez

The Centers for Medicare and Medicaid Services (CMS) have specific requirements on submissions involving risk adjustment data, which includes Hierarchical Condition Categories (HCCs). To be successful and fully compliant, it takes proactiveness in identifying and preventing coding and auditing errors which may impact your health care organization’s revenue cycle.

Join us for this information-packed webinar where industry expert Victoria M. Hernandez, share best practices and dive into the world of Medicare Advantage (MA-HCCs) and Health and Human Services Hierarchical Condition Categories (HHS-HCCs). This webinar will provide an overview of the coding guidelines and references that impact HCC coding and auditing. Victoria will also review HCC case scenarios and identify coding best practices while promoting quality clinical documentation and regulatory compliance.

As a bonus hand-outs, attendees will receive:

  • The latest CMS-HCC model
  • ICD-10-CM  Official Guidelines for Coding and Reporting FY 2020
  • ICD-10-PCS  Official Guidelines for Coding and Reporting FY 2020

Webinar Objectives


  • Review definition and background of Hierarchical Condition Category (HCCs)
  • Enhance knowledge on how to accurately identify HCCs in coding and auditing
  • Identify best practices on auditing for HCCs
  • Understand coding guideline updates and coding references impacting HCCs
  • Review multiple case examples involving HCC coding and auditing 
  • Understand regulatory directives applicable to coding including CMS Risk Adjustment Data Validation (RADV) audits 
  • Questions and Answers (Q&A with industry professionals) 

Webinar Agenda


  1. What is Risk Adjustment?
  2. What are HCCs?
  3. Overview of CMS and HHS HCC Models
    1. CMS and HHS Similarities and Differences
  4. Medicare Advantage Enrollee Statistics
  5. Coding and Auditing References/Resources
    1. Auditor Tools
    2. Factors to Consider
    3. Identify Challenges
  6. Review of HCC Practice Case Scenarios

Webinar Highlights


Let’s be diligent and proactive in preventing coding and auditing errors that may impact our health care organizations’ revenue cycle. Quality coding and auditing of medical records are essential to ensuring your organization’s compliance to regulatory directives, including risk-adjusted payers. It is important to understand all the regulatory requirements and mandates related to Hierarchical Condition Categories (HCCs), while applying coding guidelines updates.

Coding and auditing errors can greatly impact your organization’s revenue cycle, especially with Hierarchical Condition Category (HCC) risk adjusted payors like Medicare Advantage and Affordable Care Act. This webinar will cover coding guidelines and references that impacts HCCs. During the webinar, Victoria will review HCC coding and auditing best practices and promote compliance and quality clinical documentation. Join us for this informative webinar, as we review cases and identify key areas where coding and auditing errors may be prevented.

Who Should Attend


  • Hospital Coding Staff
  • Clinical Documentation Improvement (CDI) Management and Staff
  • Reimbursement Specialists
  • Coding Auditors and Educators
  • HIM Coding Supervisors, Managers and Directors
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