A billing clerk proposes copying last year’s HCC-mapped diagnoses onto this year’s claims without clinician revalidation. What is the correct coding response?
Select an answer to reveal the explanation.
Short Explanation
Copy-paste from last year’s HCC list is not clinical validation. This year’s chart has to show the conditions still live in the care story. No revalidation, no free pass to clone the risk codes.
Full Explanation
Risk-adjustment diagnoses must not be carried forward onto this year’s claims without current-year clinical documentation and validation. Copying last year’s HCC-mapped diagnoses without clinician revalidation is a compliance failure, not a RAF protection strategy. Civic clinic coding should refuse bulk cloning that invents encounter support the chart does not contain, preserving integrity of public Medicare Advantage risk scores.
Copying all prior HCC codes automatically to protect RAF scores fails by concept because scores require current supported capture, not archival paste. Carrying forward codes only when the patient has not been seen in two years fails because absence of care does not authorize phantom coding. Allowing problem-list cloning if the EHR shows a green checkmark fails because UI checkmarks are not clinical validation of this year’s assessment.
Exam caveat: chronic conditions may persist clinically, but coding still needs this year’s documentation of that persistence or management. Operational check: block charge-entry macros that import prior HCC lists wholesale; require encounter-linked diagnoses with MEAT support before submission to MA encounter data streams.