How often should diagnosis/HCC codes be captured at minimum?

The reason capturing diagnosis/HCC codes every 6 months is the minimum required is primarily related to the guidelines set forth for accurate risk adjustment and reimbursement. By capturing the codes biannually, healthcare providers ensure that the most current health status of patients is reflected in their medical records. This regular updating allows for the most accurate risk assessment, which is crucial for appropriate reimbursement from payers.

In the context of risk adjustment models, such as HCC (Hierarchical Condition Categories), the timely documentation of diagnoses is essential for maintaining an up-to-date risk profile for patients. This not only influences the financial compensation for care provided but also impacts clinical decision-making and resource allocation. Therefore, while it may seem feasible to capture codes less frequently, doing so could lead to an outdated understanding of a patient’s health status, which can affect both care continuity and financial aspects related to healthcare services provided.