Risk Adjustment Documentation & Coding
Returns must be authorized by the AMA.
Risk-adjustment practices consider chronic diseases as predictors of future healthcare needs and expenses. Correct and detailed documentation and compliant diagnosis coding are critical for proper risk adjustment.
Risk Adjustment Documentation & Coding provides:
- Risk-adjustment parameters to improve documentation related to severity of illness and chronic diseases.
- Code abstraction guidelines and best practices recommendations to improve diagnostic coding accuracy without causing financial harm to the practice or health facility.
The impact of risk-adjustment coding—also called hierarchical condition category (HCC) coding—on a practice should not be underestimated:
- More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States.
- Insurance risk pools under the Affordable Care Act include risk adjustment.
- CMS has proposed expanding audits on risk-adjustment coding.
- Meticulous diagnostic documentation and coding is key to accurate risk-adjustment reporting.
Features and Benefits
- Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, an alphabetized, topical review of clinical documentation improvement and coding for risk adjustment, and guidance for development of internal risk-adjustment coding policies
- Three appendices offering mappings, tabular information, and documentation and abstraction training tools for coders and physicians that include an alphanumeric mapping of ICD-10-CM codes that risk-adjust to HCCs and RxHCCs for Medicare Advantage plans.
Learning and design features: