Education & TrainingMedicare AdvantageNovember 18, 2024

Notice of change: Part D Rx HCCs

The Inflation Reduction Act and its impact on Part D Rx HCC model for 2025

On August 16, 2023, President Biden signed the Inflation Reduction Act (IRA) into law. This act brought about crucial reforms in the U.S. healthcare system, specifically impacting Medicare Advantage and Medicare Part D programs.

Starting January 1, 2025, the Part D Rx Hierarchical Condition Categories (HCC) risk adjustment (RA) model will undergo significant updates, reflecting the redesigned Part D benefits mandated by the IRA. This Medicare model helps categorize beneficiaries based on their overall health status and expected prescription drug costs. It will use diagnosis and drug utilization data to help predict healthcare costs associated with managing chronic conditions such as hypertension, COPD, and depression.

As part of the Part D Rx HCC model, it is essential for clinicians to thoroughly assess their patients’ active chronic conditions for presence or absence during each encounter and at least once each year. By maintaining comprehensive, accurate, and complete documentation during patient visits and coding to the highest level of specificity, providers can significantly enhance:

  • Submission of accurate and complete clinical documentation, coding, and data,
  • Appropriate resources to support effective management of costs,
  • Quality of patient care, and
  • Adherence to compliance regulations.

Thank you for your attention to these important updates. As clinicians, your commitment to accurate and complete documentation and compliant coding practices is essential. Together, we can navigate these changes and support the ongoing delivery of quality patient care.

If you have any RA Part D Rx HCC questions, please contact your Provider Success point of contact to coordinate efforts with the Enterprise Risk Adjustment team. For more detailed Part D model information, please visit the CMS website by clicking this link.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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