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An AAPC Services risk adjustment case study The value of risk adjustment is drawing more and more attention at the organization and provider levels. What used to be primarily beneficial to health plans has been trickling down to participating providers in Medicare Advantage (MA), Medicaid plans, and other value-based contracts. This introduces new questions around ...
Perform well when faced with a RADV audit. If you’re a hierarchical condition category (HCC) coder, no doubt you’ve heard of risk adjustment data validation (RADV) audits. There are various types of RADV audits that are performed by the Centers for Medicare & Medicaid Services (CMS) including contract-level RADV audits and improper payment measure audits ...
In CMS
Mar 1st, 2022
Five tips help physician practices chart a course for compliant coding. Medical coders love rules. For many of us, ambiguity is the enemy. But in risk adjustment, there are hundreds of areas for which there are no maps to the rocky shoals of compliance. The Centers for Medicare & Medicaid Services’ (CMS’) requirement of “support” ...
Know their role in helping healthcare providers improve the accuracy of patients’ RAF scores. In a risk-adjusted health plan, such as Medicare Advantage, funding for a patient’s care depends on the documented diagnoses. All current diagnoses must be identified to the highest level of specificity. Missing or incomplete documentation will lead to negative outcomes that ...
In Coding
Feb 1st, 2022
Failing to catch these common diagnosis errors can be costly for everyone involved. We all understand the importance of abstracting information from provider documentation and accurately applying ICD-10-CM codes. These codes paint the overall clinical picture of the patient encounter, as well as the severity of illness in the patient. When it comes to risk ...