HCC Buddy

What does HCC stand for in medical coding?

HCC stands for Hierarchical Condition Category. CMS uses HCC risk adjustment to estimate expected medical cost for Medicare Advantage members based on the diagnoses a provider reports during the year (CMS Risk Adjustment program: https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors).

What is the difference between HCC model V24 and V28?

V28 is the CMS-HCC model that began phasing in for payment year 2024 and reached 100% phase-in for payment year 2026. Compared to V24, V28 expands from 86 to 115 payment HCCs, removes some lower-acuity diagnosis groups, and updates RAF coefficients to reflect ICD-10-CM clinical revisions. Full details are in the CMS 2024 Advance Notice (https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/announcements-and-documents).

What is a RAF score and why does it matter?

Risk Adjustment Factor (RAF) is the numeric coefficient CMS publishes for each payment HCC. The sum of a member's HCC coefficients (plus demographic factors) drives the per-member-per-month payment a Medicare Advantage plan receives. HCC Buddy shows the V28 and V24 RAF coefficients beside each ICD-10 code so coders see risk-adjustment impact without leaving the code card. Source coefficients: CMS RA Model Output (https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors).

What does the HCC Buddy Evidence Checker do?

Evidence Checker reviews deidentified chart wording against MEAT criteria (Monitor, Evaluate, Assess, Treat) and flags documentation gaps, conflicting language, and strength-of-evidence concerns so coders can separate diagnoses that simply have an ICD-10 mapping from diagnoses that are actually supported for risk adjustment under CMS audit standards.

How many ICD-10-CM codes map to HCC categories?

The FY2026 ICD-10-CM tabular list contains roughly 72,000 codes (CMS FY2026 release: https://www.cms.gov/medicare/coding-billing/icd-10-codes), of which about 9,500 map to a CMS-HCC V28 payment category. HCC Buddy shows the HCC value, model version, and source period for each billable code.

Is HCC Buddy free to try?

Yes. Start Pro and get 14 days to try the full workflow. Pro is $19.99/month for founding members during the founding window, then $29.99/month after it closes. The annual plan is $199.99/year.

Can I paste patient notes into Ask Buddy?

No. HCC Buddy is built for deidentified coding questions, ICD-10-CM codes, and clinical concepts. Do not paste member identifiers, dates of birth, full chart notes, or other patient identifiers into Ask Buddy.