Annual Recapture in Risk Adjustment: Why Last Year’s Diagnosis Is Not Enough

Answer in brief
The CMS-HCC model is prospective. CMS materials explain that the model uses diagnosis information from a base year, meaning the prior year, to estimate expenditures in the next year. That is why last year’s diagnosis is not enough by itself for the next cycle unless the condition is documented again in the current capture year when it is still active. 

Why annual recapture exists

CMS’s methodology documents say risk scores for a given year are calculated using diagnosis information from the prior year. CMS’s managed care guidance also describes the data collection period as the calendar year before the payment year for mid-year and final risk scores.

Why “we had it last year” fails

CMS’s deadline memo says diagnoses submitted after the final deadline are not included and only deletes are processed afterward. So current-year recapture is not just a documentation habit; it is built into the payment calendar.