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HCC V28 is fundamentally the newest release of the CMS Hierarchical Condition Category model, properly referred to as the CMS HHS Risk Adjustment Model. This model has become the exclusive standard for calculating risk scores for Medicare Advantage beneficiaries after years of phasing in updates.

Specificity forms the basis of reimbursement in the field of medical billing. This is especially the case when it comes to respiratory diagnosis, in which a cough is seemingly a simple symptom that should be diagnosed with care. Coders have over the years been using the same code to describe cough yet recent amendments have brought a lot of change in this field.

Medicare Advantage has been at a critical crossroad. By January 1, 2026, the three-year transition to the new version 28 (V28) of the CMS Hierarchy Condition Category model version 24 (V24) is done. umbers 100% of risk adjusted payment are currently computed under the V28 model only, and not on any other payment year than 2026.

Patient care is a time-constrained dimension. In most services of medical billing, the degree of reimbursement directly correlates to the amount of time spent by a physician or skilled health professional.

Have you ever filed a clean claim and had it rejected weeks after with some kind of reason that did not make sense? Calculation of units is one of the most common, but confusing reasons behind claims denials. You may believe that it is easy to bill a single vial of a drug.

Pharmaceutical identification is entering a major revolution in its landscape. In March 2026, the Food and Drug Administration (FDA) published a final rule that will eventually bring the format of the National Drug Code (NDC) into harmony.

Nutritional counseling has ceased to be an extremity of wellness to become the core aspect of prevention medicine and chronic illnesses. With the recent transition to value based care in healthcare, the services that are coded under dietary and nutrition counseling have been extremely important as sources of revenue to practices.

In the complex system of medical billing, precision is what lies between a clean claim and an expensive denial. There are not many aspects of the surgical coding that depict this fact more than the bilateral procedures.

Denial codes in medical billing can have a considerable effect on revenue and efficiency of the workflow. The CO-16 Denial Code is one of the denials that billing staff has to face. This code is important to understand in order to reimburse on time and to have a smooth revenue cycle.