Year End Push | Closing Risk Adjustment Coding Gaps

Bradenton, Florida
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Good Afternoon Friends,

I am looking for feedback and ideas from both providers and health plans on year end pushes to get coding gaps closed.

We have been working hard all year both on the plan side as well as the provider side to see members/patients, assess their chronic conditions, and get them documented & coded but as we all know it seems we always have more gaps to close!

I am looking for any ideas to try over the next 30 days that may help us exceed our goals in risk adjustment. I would love to hear some provider thoughts on what works best for you at the end of the year and how the plan can maybe assist you in getting members in or different strategies you may be trying.

Wishing you all a happy and safe holiday season!

Nicole Martin


Lithonia, GA
Best answers
Risk Adjust Coding Gaps


This is late responding message but hope it helps. First your docs must document in a very detailed (helps those coders when abstracting) way per any illness. The chronic conditions range from ongoing DM, CVA, Cancers, HIV,ESRD, Respiratory problems,Disorders of Immunity, Drug and Alcohol problems, Depression and Cardiac problems, Hepatitis, Pancreas, and infectious disease, Liver, amputations, artificial openings, and do not forget BMI index. The doc needs to check for either on regular basis OR every year (maybe January) when the patient gets their annual physical. Also ensure your coders are listing all dx. codes on the claim derived from the medical record for the day treatment. I have seen some coder only list one or 2 dx despite the doc giving 8 or up to 12. This is upsetting the stats on patient care which is especially monitored by Medicare and other payers.

Also if the doc puts in documentation the patient has certain details need to list it such as; paralyzed on side from heart attack or stroke, pacemakers, or any deformed, extremely overweight, debility, using oxygen, blind, etc. These details must be put in each time patient is treated. The HCC disease list describes it better.

I hope this information helps you

Lady T