Understanding Why HCC Scores Can’t Predict Capitation Rates for Medicare Advantage Organizations

ICD10monitor February 8, 2023
Frank Cohen

HCC scores also don’t predict costs (or payments).

EDITOR’S NOTE: This is the second and final article in a two-part series about Hierarchical Condition Category (HCC) risk scores. Part I can be found here.

In my last article, I wrote about how one could use HCC risk adjustment scores to identify providers that may possibly be coding inappropriately – that is, over-coding or under-coding. The article also focused on how benchmarking against a calculation of averages would help to prioritize clinical documentation improvement (CDI) efforts.

But there’s a bigger story here, as far as I am concerned, and that is whether there is really any value to using those risk scores to establish and adjust capitation rates for Medicare...

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