Risk Adjustment Coding


Risk Adjustment Coding is becoming an integral component of healthcare reimbursement.  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. This model identifies individuals with serious or chronic illness and assigns a Risk Factor score to the patient based upon a combination of the individual’s health conditions and demographic details (called the Risk Adjustment Factor or Risk Factor ).

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.