Practice Provider

Blog

The Importance of Documentation in Risk Adjustment Coding

What is risk adjustment coding?

Risk adjustment coding is part of a payment model that was mandated by CMS/Medicare Medicaid Services in 1997. This model identifies 79 categories of individuals with serious or chronic illness. These individuals assigned a risk factor score -- called a risk adjustment factor -- based on a combination of their health conditions and demographic details. Each of these risks have specific codes that must be included in a patient’s chart.

Read more: The Importance of Documentation in Risk Adjustment Coding

What is MEAT?

Coding guidelines specify that ICD-10 codes reported on health insurance claims should be supported by the documentation in the medical record in order to qualify for reimbursement.  To properly do so, a patient’s medical record must explicitly state that a condition was Monitored, Evaluated, Assessed or Treated (MEAT).

Read more: The Basics of MEAT Guidelines

What are Hierarchical Condition Codes (HCC)?

Hierarchical Condition Codes (HCC) were created by the Centers for Medicare & Medicaid Services (CMS). The HCC codes are used to identify 79 categories of conditions based on individuals with serious or chronic illnesses (such as diabetes or HIV/AIDS). Within each of the HCC categories are specific groupings of conditions drawn from more than 10,000 ICD-DM codes. 

Read more: The Basics of Hierarchical Condition Codes (HCC)

What is Risk Adjustment Coding?

Risk adjustment coding is part of a payment model that was mandated by the Centers for Medicare & Medicaid Services (CMS) in 1997. This model identifies 79 categories of individuals with serious or chronic illnesses. Each of these illnesses (such as diabetes or HIV/AIDS) have specific risk adjustment codes that must be documented in a patient’s medical record and submitted with a corresponding claim. The process of identifying these risk adjustment codes is called risk adjustment coding.

Read more: The Basics of Risk Adjustment Coding (Alternate: What You Need to Know About Risk Adjustment Coding)

SOC2 Certification

Healthcare News


... read more