RISK ADJUSTMENT CODING HEDIS AND DOCUMENTATION Provider Education
- Slides: 33
RISK ADJUSTMENT CODING, HEDIS, AND DOCUMENTATION Provider Education Training 02/18/2021
OBJECTIVES FOR TODAY ü Discuss the Risk Adjustment methodology ü Understand how complete and accurate documentation and coding supports good patient care ü Tying in Quality and HEDIS measures ü Tips for accurate and complete documentation and coding of common conditions
WHAT IS RISK ADJUSTMENT? ü Risk Adjustment is the mechanism by which government programs adjust the revenue to health plans based on the health status of the covered population(s).
BENEFITS OF RISK ADJUSTMENT
RISK SCORE CALCULATION
RISK ADJUSTMENT MODELS
RISK ADJUSTMENT MODELS ü Disease groups contain major diseases and are broadly organized into body systems ü HCCs (Hierarchical Condition Categories) Medicare ü HCCs allow for payment for only the most severe or complicated illness within a category ü Each HCC has an associated risk weight
PY MEDICARE ADVANTAGE RISK ADJUSTMENT MODEL > 70, 000+ ICD-10 Diagnosis Codes 805 Disease groups 189 Condition Categories 79 HCCs
ACUITY AND SPECIFICITY Because ICD-10 -CM codes are used in risk adjustment, the documentation of acuity and specificity can be significant. These are some examples of the increased specificity needs that are important to include in the documentation for risk adjustment:
ACUITY AND SPECIFICITY (CONTINUED)
PHYSICIAN’S ROLE
WHERE CAN YOU FIND DIAGNOSIS CODES? Anywhere in the medical record!
MEDICAL RECORD DOCUMENTATION TIPS
COMMONLY OVERLOOKED DIAGNOSES
PAST MEDICAL HISTORY
MEAT
MEAT (CONTINUED)
CURRENT VS HISTORY OF
SPECIFICITY
QUALITY & RISK ADJUSTMENT
ANNUAL WELLNESS VISITS
ANNUAL WELLNESS VISITS
COMMON REPORTED DISEASES RISK ADJUSTMENT & HEDIS
MALIGNANT NEOPLASM CODING TIPS
HEDIS: CANCER
Diabetes Coding Tips 4/10/2018
HEDIS: Diabetes 4/10/2018
Hypertension Coding Tips
HEDIS: NEPHROPATHY SCREENING
DEPRESSION CODING TIPS
Asthma Coding Tips 4/10/2018
BMI CODING TIPS
THANK YOU!! Hosted by: Mechelle Reed Vice President of Configuration, Credentialing & Risk Adjustment Any questions can be directed to the Provider Services email at Provider_Services@universalcare. com