What is the goal of capturing HCC diagnoses?

• A. To allow health plan to submit the most complete and accurate health status to the government's risk adjustment agency.
• B. To reduce claims processing time.
• C. To increase CPT code submission.
• D. To minimize ICD-10-CM usage.

Answer: (A)

Capturing HCC diagnoses is about accurately conveying a patient’s health burden for risk adjustment. In risk-adjustment programs, diagnoses reported as ICD-10-CM codes are mapped to Hierarchical Condition Categories and used to compute a risk score that drives payments to health plans. The goal is to submit the most complete and precise health status so the risk score truly reflects the enrollees’ expected costs. This ensures fair funding and that sicker patients have appropriate resources. It’s not about speeding up claims processing, nor about increasing CPT code submissions, and ICD-10-CM usage is essential here—reducing it would weaken the accuracy of the risk adjustment.