Which of the following is most likely the reason why recalculation score for the patient is not displaying?

A Health Cloud administrator has set up risk recalculation by setting the recalculate flag to TRUE but is not seeing the recalculation score for the patient.

Which of the following is most likely the reason why recalculation score for the patient is not displaying?
A . Use the CMS recalculation API
B . Risk scores are only recalculated for patients who are affiliated with a care program.
C . CMS scores cannot be recalculated in health cloud.
D . Use a 3 – Apply to Real World / Analyze / Evaluated party API to recalculate CMS risk score.

View Answer

Answer: B

Explanation:

Reference and details below.

According to the Health Cloud Data Model Developer Guide, Risk scores are only recalculated for patients who are affiliated with a care program is the most likely reason why recalculation score for the patient is not displaying. Risk scores are calculated based on CMS-HCC (Centers for Medicare & Medicaid Services – Hierarchical Condition Categories) model, which assigns risk factors to patients based on their diagnoses and demographic factors. Risk scores are used to adjust payments for

health plans and providers. Risk scores are only recalculated when the recalculate flag is set to TRUE and the patient is affiliated with a care program. Using CMS recalculation API is not a valid reason, as CMS recalculation API is not a feature of Health Cloud. CMS scores cannot be recalculated in health cloud is not a valid reason, as CMS scores can be recalculated in health cloud by setting the recalculate flag to TRUE. Using a third party API to recalculate CMS risk score is not a valid reason, as it has nothing to do with displaying the recalculation score.