How many charts can be submitted to CMS to validate an HCC?

The correct understanding of the process for validating a Hierarchical Condition Category (HCC) involves submitting a total of five charts to the Centers for Medicare & Medicaid Services (CMS). This requirement is in place to ensure a comprehensive review of patient records that adequately supports the diagnosis coding and corresponding HCCs for risk adjustment purposes. The submission of five charts allows for a thorough assessment of the clinical documentation and coding practices, as it provides CMS with a diverse sample of patient encounters, ensuring that there is sufficient evidence to support the diagnoses reported for the sampled population. This validation process is crucial for maintaining the integrity of the risk adjustment model and ensuring that healthcare organizations are accurately reflecting the resource utilization associated with their patient population.