HCC Coding

HCC coding (Hierarchical Condition Categories) is the risk adjustment methodology used by Medicare Advantage and ACA plans to score patient acuity and set reimbursement. The work involves chart abstraction, supportable diagnosis identification, evidence documentation, and submission against tight payer deadlines — historically driven by chart-chase teams and annual sweeps. Penguin Ai's HCC retrospective solution runs continuously instead of in waves: every patient chart is reviewed for documented and supportable HCC conditions across the longitudinal record, with chart citations, coding rules, and rationale attached to every suspect for coder and clinician validation.