As CMS rolls out the TEAM Mandate, one area is under unprecedented scrutiny: risk capture through Hierarchical Condition Categories (HCCs). At the core of this challenge lies a silent disruptor—HCC code crosswalks. If your crosswalk logic isn’t aligned with TEAM requirements, your risk scores—and ultimately your reimbursements—could be off target. In this article, we’ll break down what HCC crosswalks are, how TEAM changes the game, and what healthcare leaders must do to protect their bottom line.

HCC code crosswalks are logic maps that connect:

• ICD-10 diagnosis codes from clinical documentation
• To CMS-defined HCC categories used in risk adjustment models

They ensure the right diagnoses trigger accurate risk weights. The complexity? Not every ICD-10 maps cleanly to a single HCC—and updates are frequent.

Why HCC Accuracy Matters Under TEAM

With TEAM, CMS is introducing dynamic episode-based risk scoring, which requires:

• Real-time validation of submitted diagnosis codes
• Accurate mapping from the encounter level up to HCC aggregation
• Tighter scrutiny on “suspect but unsubstantiated” codes

Key Risks of Inaccurate Crosswalks:

• Undercoding: Leading to lost revenue
• Overcoding: Triggering audits and potential clawbacks
• Stale mappings: Failing to reflect quarterly CMS updates

TEAM’s Enhancements to the HCC Risk Adjustment Model

The TEAM mandate brings several updates to how risk capture is evaluated:

• Encounter-based documentation logic now supersedes static historical flags

• TEAM mandates temporal logic (e.g., recent vs. chronic conditions)

• Inclusion of social drivers of health (SDoH) into weighted risk scores

• Expansion of bundled episode definitions, creating tighter diagnosis boundaries

Optimizing HCC Code Crosswalks: What Healthcare Systems Must Do

Here’s a step-by-step playbook:

• Audit Your Current Crosswalk Tables
  Validate against latest CMS HCC model (v28 or current TEAM variant)

• Implement AI-Assisted Code Suggestion Tools
  Ensure coders get real-time prompts for accurate mapping

• Monitor Episode Triggers Closely
  Use TEAM-compliant logic to flag when risk scores reset

• Build a Feedback Loop
  Create dashboards for coding teams to review risk score deltas

• Train Providers on “Crosswalk-Sensitive” Diagnoses
  E.g., conditions like CHF, CKD, or COPD that often fall into multiple HCC buckets

SolvEdge Insight: How We Solve the Crosswalk Puzzle

SolvEdge’s compliance platform offers intelligent HCC mapping with:

• Auto-updating crosswalk tables synced to CMS quarterly updates

• Episode-aware risk capture engine aligned to TEAM requirements

• Real-time coding feedback to prevent missed or incorrect captures

• Custom dashboards to monitor HCC volatility and audit risk

• Built-in alerts for under-documented episodes

SolvEdge empowers your team to turn every diagnosis into a defensible, optimized risk score

Common Pitfalls in TEAM-Linked HCC Mapping

Avoid these errors as you implement TEAM-compliant workflows:

Pitfall	Description	Impact
Static Crosswalks	Using outdated tables	Missed revenue or misaligned risk
Lack of Physician Input	No feedback on documentation gaps	Poor substantiation of HCCs
Ignoring Temporal Logic	Overusing historical diagnoses	CMS score rejection
Overreliance on Coders Alone	No automation	Scalability bottlenecks

Get Your HCC Crosswalks TEAM-Ready

HCC risk capture is the backbone of revenue integrity in value-based care—and TEAM raises the bar for accuracy, speed, and accountability. Healthcare organizations must modernize their crosswalk logic, documentation workflows, and audit trails to meet CMS’s expectations and protect financial viability.