What are catastrophic vs non-catastrophic HCCs?

• A. Catastrophic HCCs denote high-severity, high-cost conditions with higher weights; non-catastrophic HCCs carry lower weights.
• B. Catastrophic HCCs have lower weights.
• C. They are unrelated to cost.
• D. They refer to data completeness rather than severity.

Answer: (A)

In HCC risk adjustment, each diagnosis category is assigned a weight that reflects its impact on expected future healthcare costs. Catastrophic HCCs are the high-severity, high-cost conditions, so they carry higher weights because they drive a larger portion of a patient’s projected spending. Non-catastrophic HCCs are less severe and lead to smaller cost increases, so their weights are lower. This weighting system helps the overall risk score capture how much a patient’s conditions are likely to cost the health plan or payer over a year. They’re about cost prediction, not data completeness, and they’re not characterized by lower weights for catastrophic conditions.