Certified Risk Adjustment Coder (CRC)

What is a key advantage of the blended model used in HCC risk adjustment?

1. Eases the transition from one year's model to the next

2. Requires more resources for coding under two different models

3. Allows fee-for-service model into the risk adjustment factor score

4. Results in substantial revenue loss in the first year

The correct answer is: Eases the transition from one year's model to the next

The blended model in Hierarchical Condition Categories (HCC) risk adjustment incorporates elements from both the previous and current coding models, creating a smoother transition. This approach allows healthcare providers and coders to adapt over time, minimizing disruption that can come from a sudden shift to a new model. By easing the transition, providers can maintain more consistent coding practices, which helps in stabilizing reimbursement rates during times of change. This blend ensures that the risk adjustment factor scores reflect patient risk more accurately, as it captures a broader range of conditions that could be relevant under both models. In contrast, requiring more resources for coding under two different models would complicate the process rather than streamline it. Allowing the fee-for-service model to influence risk adjustment scores does not necessarily connect with the aspect of the blended approach, as it primarily focuses on integrating different risk adjustment methodologies. Finally, rather than resulting in substantial revenue loss, the blended model aims to provide stability and mitigate significant financial impacts during transitions, which enhances confidence in the reimbursement process.