A primary-care clinic participates in Medicare Advantage risk adjustment. A patient’s chronic HCC-relevant conditions were coded last year but have not been addressed in the current calendar year. What annual-capture principle should guide the coding team?
Select an answer to reveal the explanation.
Short Explanation
Risk adjustment is a yearly race, not a lifetime trophy. Chronic conditions that matter for HCCs usually need to be documented and coded again in the current year. Last year’s codes do not babysit this year’s score by themselves.
Full Explanation
Medicare Advantage risk adjustment typically requires that HCC-relevant chronic conditions be supported by provider documentation and reported in the applicable payment year. Prior-year coding does not automatically carry forward. Problem-list entries without current encounter support and assumptions that demographics alone suffice undermine compliant annual capture. Clinics should ensure chronic conditions are monitored, evaluated, assessed, or treated and coded in the current year when clinically appropriate.