A clinic revenue-cycle huddle reviews how Medicare Advantage risk scores are built. Beyond demographics, what is the coder’s primary contribution to the risk-score story?
Select an answer to reveal the explanation.
Short Explanation
Demographics set the baseline; diagnoses fill in how complex the patient is. The coder’s job is accurate, supported ICD-10-CM—not inventing CPT tricks or POS games to juice a risk score. Get the diagnoses right and the model can do its mapping.
Full Explanation
Risk scores combine demographic factors with diagnosis-driven HCC categories. The coder’s contribution is assigning accurate, medically supported ICD-10-CM codes that may map to HCCs—not manipulating CPT RVUs, place of service, or modifiers as risk-score levers. Procedure coding remains important for claims payment but does not substitute for diagnosis capture in HCC risk adjustment.