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Risk Adjustment and HCC Coding

  1. #1
    Default Risk Adjustment and HCC Coding
    Exam Training Packages

    I wonder if anyone is working in the Risk Adjustment area and can share some experience on ways to increase and maintain risk scores?


  2. #2
    Default Increasing RAF Scores
    The key to higher RAF Scores is Documentation and recurrent visits. The physician really needs to see each patient with Chronic conditions every 6 months as RAF scores are re-calculated in Jna and July.

    The documentation has to be very specific and then of course, you need to code to that same specficity. Another thing that has helped our Docs is if your Medicare Advantage plan has a portal with past conditions reported, print that sheet out, put it on top of the patient chart for each visit. This lets them know it is a Medicare Advantage member, to document better and also reminds them of all the chronic conditions he/she should address for each visit to ensure they are reported for each calculation period.

    I hope this helps.

  3. #3
    Kansas City, MO
    Make sure your doc is documenting the diagnoses very specifically so you can code to the highest specificity. Instead of just jotting down "DM", if there are other problems, make sure he puts those down to and if they are related..."peripheral neuropathy due to diabetes" or "insulin dependent diabetes".

    Be familiar with what dx's qualify as HCC's so you can educate where needed.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  4. #4
    Thanks guys. Another challenge we are facing is to increase provider's awareness about the impact on their risk scores. Most of them are still used to the FFS concept that they focus on CPT instead of ICD. Seems like it takes forever for doctors to realize this "not so new" trend about Risk Adjustment.

  5. #5
    Default HCC Documentation
    One thing our Medicare Advantage Plans have is a Provider Portal. From this portal we can access RAF Sheets for each member which shows what diagnosis were previously reported for this patient. Before each visit, the staff prints this sheet, attaches it to the patients record and this tell the Doc it is an MA plan patient. It also lets the Doc know what chronic conditions the patient has and prompts them to evaluate/document each condition on the list.
    Last edited by Mnigma; 04-25-2011 at 12:29 PM. Reason: Spelling

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