Risk adjustment practices consider chronic diseases as predictors of future healthcare needs and expenses. 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.
AMA's risk adjustment coding guide features:
- 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
- “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 and coding skills (exclusive to Chapter 4)
- Extensive end-of-chapter “Evaluate Your Understanding” sections that include multiple-choice questions, true-or-false questions, audit exercises, and Internet-based exercises
- Two downloadable course tests and slide presentations for each chapter
- Exclusive content for academic educators: A test bank containing 100 questions and a mock risk-adjustment certification exam with 150 questions.