Certified Risk Adjustment Coder (CRC)

What is the primary focus of the Hierarchical Condition Category (HCC) model?

1. To reduce healthcare costs.

2. To classify the severity of diseases.

3. To improve coding accuracy.

4. To assign risk adjustment factors for reimbursement.

The correct answer is: To assign risk adjustment factors for reimbursement.

The primary focus of the Hierarchical Condition Category (HCC) model is to assign risk adjustment factors for reimbursement. The HCC model was developed to better align risk-adjusted payments in Medicare and other health programs with the resources necessary to provide adequate care to patients based on their health status and chronic conditions. This process involves categorizing patients based on their diagnoses to determine their expected healthcare costs. By doing so, the model helps ensure that healthcare providers are reimbursed fairly based on the relative risk and complexity of the population they serve. While reducing healthcare costs, classifying the severity of diseases, and improving coding accuracy are important considerations in healthcare and coding, they are secondary effects of the HCC model. The primary intent remains to calculate and assign risk adjustment factors that reflect the expected healthcare costs associated with patient populations, ensuring that providers can deliver the appropriate care level while receiving adequate compensation.