Which provider is NOT an approved provider for diagnosis code capture under the HCC model?

In the context of the Hierarchical Condition Categories (HCC) model, the types of providers empowered to capture diagnosis codes play a crucial role in risk adjustment. The HCC model relies on specific healthcare professionals who are eligible to bill for services and document diagnoses that impact patient risk scores.

A registered nurse typically performs clinical assessments and provides care under the supervision of a physician or other advanced practice providers, but does not have the authority to independently document diagnoses for the purposes of risk adjustment under the HCC model. Therefore, the involvement of a registered nurse in capturing diagnosis codes does not meet the criteria established by CMS for the HCC model.

In contrast, licensed clinical social workers (LCSWs), certified registered nurse anesthetists (CRNAs), and podiatrists are all recognized by CMS as approved providers for capturing diagnoses. These professionals have distinct roles that allow them to evaluate and document patient conditions relevant to risk adjustment, thereby ensuring accurate representation of a patient's health status.

Understanding the specific roles and regulatory guidelines surrounding diagnosis code capture under the HCC model is essential for proper compliance and accurate risk assessment in healthcare settings.