What type of conditions does the Suspect Generation rely on to identify suspected cases?

The identification of suspected cases in the Suspect Generation process relies on prescribed medications and therapy because these elements provide crucial insights into a patient's medical history and treatment needs. Prescriptions often indicate the presence of chronic conditions that require ongoing management, which makes it easier to suspect certain diagnoses based on the therapeutic interventions being utilized. For instance, if a patient is receiving medications for diabetes, hypertension, or other chronic diseases, it raises the likelihood of these conditions being relevant for coding and risk adjustment.

While lab tests, insurance claims, and psychiatric evaluations may contribute to the overall clinical picture or be components of a broader assessment, they do not provide a comprehensive view of the therapeutic decisions made by healthcare providers. The integration of medication history and the types of therapies being prescribed play a significant role in determining the suspected health status of patients, making this choice the most relevant in the context of Suspect Generation.