HCC Coding and Risk Adjustment Practice Test 2025 - Free Practice Questions and Risk Adjustment Study Guide

Question: 1 / 400

In which segment does the CMS-HCC model operate primarily?

Outpatient care

Medicare Advantage plans

The CMS-HCC model primarily operates within Medicare Advantage plans. This model is designed to assess and adjust risk based on the health status of the enrollees in these plans. It uses hierarchical condition categories (HCCs) to capture the severity of individual patients' health conditions, which in turn informs the payment structures for these plans. The focus on Medicare Advantage is significant because it allows for a comprehensive understanding of the patient population, influencing reimbursement and care management strategies tailored to the needs of individuals enrolled in these programs.

The other options represent areas where risk adjustment may be relevant but are not the primary focus of the CMS-HCC model. Outpatient care, long-term care facilities, and private insurance markets have different frameworks and methodologies for risk adjustment that do not primarily utilize the CMS-HCC model as their main mechanism.

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Long-term care facilities

Private insurance markets

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