December 1, 2025
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The Day I Discovered Half Our HCC Codes Were Built on Wishful Thinking

Tuesday afternoon, 3:47 PM. I’m reviewing audit results when my stomach drops. Forty-three percent of our submitted codes just failed validation. Not because we coded wrong conditions. Because our risk adjustment HCC coding was based on assumptions, not documentation. We’d been coding “diabetes with complications” every time we saw metformin and an ACE inhibitor together.

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