Risk Adjustment Documentation & Coding

Risk Adjustment Documentation & Coding

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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:
Vocabulary terms highlighted within the text and conveniently defined at the bottom of the page
“Advice/Alert Notes” that highlight important coding and documentation advice from federal regulatory sources
“Sidebars” that provide derivative story and additional information, such as
“Coding Tips” that guide coders with practical advice from sources like AHA’s Coding Clinic and cautionary notes about conflicts and exceptions
“Clinical Examples” that underscore key documentation issues for risk adjustment
“Clinical Coding Examples” that provide snippets or full encounter notes and codes to illustrate risk-adjustment coding and documentation concepts
“Documentation tips” that highlight recommendations to physicians regarding what should be included in the medical record or how ICD-10-CM may classify specific terms
“Examples” that explain difficult concepts and promote understanding of those concepts as they relate to a section
“FYI” call outs that provide quick facts
“Abstract & Code It!” exercises that test diagnosis abstraction & coding skills (exclusive to Chapter 4)


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