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coding-hcc-risk-adjustment

Map ICD-10-CM diagnoses to CMS-HCC V28 categories and estimate RAF scores.

5.0k|615|Updated Oct 4, 2025
Search Tags:#icd-10-cm#medical coding#risk adjustment#raf#hcc#cms-hcc#meat documentation
One-click install
npx skills add https://github.com/maziyarpanahi/openmed --skill coding-hcc-risk-adjustment
Or copy as Structured Prompt for Agent▼
Please help me install this Agent Skill.
Skill: coding-hcc-risk-adjustment
Source: https://github.com/maziyarpanahi/openmed/tree/main/skills/coding-hcc-risk-adjustment
Command: npx skills add https://github.com/maziyarpanahi/openmed --skill coding-hcc-risk-adjustment

SYSTEM DOCUMENTATION & REQUIREMENTS

What problem does it solve?

This Skill helps coders and clinicians identify chronic conditions that may qualify for CMS-HCC V28 risk adjustment, connect ICD-10-CM diagnoses to HCC categories, and estimate RAF scores without treating the result as autonomous coding.

Core Features & Use Cases

  • HCC Mapping: Map ICD-10-CM diagnosis codes to CMS-HCC V28 categories using official CMS crosswalks.
  • RAF Estimation: Apply HCC hierarchies and model coefficients to estimate disease and total RAF components.
  • Documentation Review: Link candidate HCCs to note evidence and assess MEAT support for monitoring, evaluation, assessment, or treatment.
  • Use Case: Review a clinical note for suspected or recaptured HCCs, identify unsupported mentions such as historical or negated conditions, and produce an auditable candidate list for coder or clinician validation.

Quick Start

Use the coding-hcc-risk-adjustment skill to map the documented conditions in the provided clinical note to CMS-HCC V28 categories, apply the appropriate hierarchy and coefficients, and return candidate HCCs with RAF estimates and MEAT evidence for human review.

Frequently Asked Questions about coding-hcc-risk-adjustment

High-intent search queries and answers about installing and using this skill.

FAQPage Schema
How do I map ICD-10-CM diagnosis codes to CMS-HCC V28 categories for risk adjustment?▼

Mapping ICD-10-CM diagnoses to CMS-HCC V28 categories requires official CMS crosswalks and hierarchy tables to link chronic conditions to HCCs and estimate RAF scores for Medicare Advantage coding support.

What is the best way to estimate RAF scores from clinical notes for Medicare Advantage coding?▼

Estimating RAF scores from clinical notes involves applying CMS-HCC V28 model-segment coefficients to documented conditions, identifying suspect HCCs, and producing an auditable candidate list for human validation.

How does MEAT documentation review work for HCC diagnosis recapture?▼

MEAT documentation review for HCC diagnosis recapture evaluates clinical notes for evidence of monitoring, evaluation, assessment, or treatment to confirm whether candidate HCCs are supported and identifies unsupported historical or negated conditions.

Can I use this for RAF reconciliation and suspect HCC identification without autonomous coding?▼

RAF reconciliation and suspect HCC identification are supported by generating an auditable candidate list with RAF estimates and MEAT evidence, but all outputs require human validation before final coding or submission.

Do I need official CMS V28 crosswalks and hierarchy tables to calculate risk-adjustment factor scores?▼

Yes, calculating risk-adjustment factor scores requires official CMS V28 crosswalks, hierarchy tables, and model-segment coefficients to accurately map diagnoses and apply the correct RAF coefficients.

What are the limitations of automated HCC mapping for clinical note review?▼

Automated HCC mapping does not perform autonomous coding; it produces candidate HCCs with RAF estimates and MEAT evidence that require human validation, and it may flag unsupported mentions such as historical or negated conditions.

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