Which two databases are cited as helping determine patient risk?

• A. HCC and ERA
• B. EHR and PHI
• C. ICD-9 and CPT
• D. HL7 and FHIR

Answer: (A)

To determine patient risk, you rely on data that captures both a patient’s chronic health conditions and their healthcare utilization. HCC, or Hierarchical Condition Category, is a coding framework that groups diagnoses into risk-adjusted categories, allowing you to quantify how a patient’s chronic conditions contribute to overall risk and expected costs. ERA, Electronic Remittance Advice, brings in payer-adjudicated claims data—covering diagnoses, procedures, service dates, and payments—that reveals real-world healthcare utilization and comorbidity patterns. Together, these two databases provide structured, objective signals about a patient’s health status and the intensity of their care, making them highly effective for risk stratification and risk-adjusted analyses.

Other options point to kinds of data or standards rather than specific databases used for risk assessment. Electronic Health Records describe broad patient data; Protected Health Information is a privacy category, not a data source; ICD-9 and CPT are coding systems, not databases; HL7 and FHIR are data-exchange standards, not risk databases.