Certified Risk Adjustment Coder (CRC)

Which provider types are unacceptable data sources under the HCC model?

1. A. Excluded providers

2. B. Children hospitals

3. C. Rural health clinics

4. D. A variety of provider types

The correct answer is: A. Excluded providers

Unacceptable data sources under the Hierarchical Condition Category (HCC) model primarily comprise excluded provider types. This means that any medical documentation or patient data collected from these providers cannot be used for risk adjustment purposes. The purpose of the HCC model is to appropriately capture the health status and expected costs of patients based on their reported diagnoses. Therefore, data collected from providers that are not considered valid or reliable sources can compromise the accuracy of the risk adjustment process. Excluded providers generally include those that do not participate in certain Medicare programs or do not fit within the framework of recognized healthcare settings that contribute to risk scoring. In contrast, the other options, such as children's hospitals, rural health clinics, and a variety of provider types, might still be acceptable sources for data collection, depending on the specific circumstances and the types of services they provide. Therefore, understanding which provider types are excluded is crucial for successful and accurate coding within the HCC model.