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The Importance of Documentation in 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 illness. These individuals are 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 has specific codes that must be included in a patient’s chart.
Read more: The Importance of Documentation in Risk Adjustment Coding
The Basics of MEAT Guidelines
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
The Basics of 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-10 codes.
Read more: The Basics of Hierarchical Condition Codes (HCC)
The Basics of 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
