Risk Adjustment Coding


The Centers for Medicare and Medicaid Services (CMS) uses a risk adjusted calculation in order to properly reimburse private insurers that manage Medicare recipients through Medicare Advantage plans. CMS has expanded the use of this methodology to calculate the benchmark budget goals for Accountable Care Organizations (ACO) participants in the Medicare Shared Savings Program (MSSP) and is also being used in the public Healthcare exchange.

There are more than 10,000 ICD10 codes that map to 79 Hierarchical Condition Category codes in the risk adjustment model. Not properly capturing ICD10 codes that risk adjust will financially impact your practice.

Practice Provider has developed an extensive training and implementation program along with an online tool to assist your practice in properly capturing, documenting and reporting chronic conditions that accurately describe the status of your patients. Contact Practice Provider today to learn more about this program.