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What we'll cover today. • What's risk adjustment (RA) coding and why is it done? • Defining Hierarchical Condition Categories (HCC) and. Risk Adjustment Factors (RAF). • Impacts to providers. • Wellness visits. • CMS audits. • Correct coding guidelines. • Medicare Advantage provider website. • Questions?
Medicare Risk-Adjustment. & Correct Coding 101. Provider Training. Rev. 10_31_14 . Implementation of ICD-10 will significantly impact the number of HCCs and the number of diagnosis codes currently in effect;. ICD-9 . Admission history and physical must be valid for IP record coding guidelines;. ? Consults during the
17 May 2017 Solutions. Value Driven. Health Care. Solutions. Agenda. »Introduction to HCC & Risk. Adjustment. »FFS Coding vs. HCC Coding. »Coding Rules . ICD-10 Code. ICD-10 Description. HCC. Group. Risk Adjusted. Factor. F329. Major depressive disorder, single episode, unspecified. 0. 0.00. F320.
28 May 2017 The CMS-HCC risk adjustment model is based on ICD-10-CM codes only, not PCS, CPT or HCPCS codes. Code assignment must be in accordance with the International Classification of Diseases (ICD), Clinical Modification Guidelines for Coding and Reporting. There is no sequencing in CMS-HCC.
19 Mar 2014 Hierarchical Condition Category (HCC) coding may be a foreign concept for some coders, but making sure documentation for Medicare Advantage patients supports it The CMS Risk Adjustment Model also measures the disease burden that includes HCCs, which correlate to ICD-9-CM diagnosis codes.
coding guidance. This training is based on coding guidance from the Official ICD-10 Coding Guidelines,. American Hospital Association's (AHA) Coding Clinic, Risk Adjustment o. Medicare Risk Adjustment o. The Risk Score o. Hierarchical Condition. Categories (HCC) o. Provider's Role. 5. Y0114_16_26958_I_02/18/
14 Jun 2016 Advantage Part C • Introduction to Medicare Advantage Part D • Risk Adjustment • Hierarchical Condition Category • Revised 2014 Risk Adjustment Payment Model • Example of HCC and ICD-9 Code Mapping • Risk Score • Coding Exclusions • Acceptable Physician Specialty Types • General Guidelines
27 Apr 2016 Where Do HCCs Factor In? In the U.S. Department of Health & Human Services Hierarchical Condition Category (HHS-HCC) risk adjustment model, a value is assigned to each diagnosis code that falls into the payment model. The ICD-10-CM codes are then grouped into an HCC.
The individual's health conditions are identified via International Classification of Diseases – 10 (ICD –10) diagnoses that are submitted by providers on incoming claims. There are more than 9000 ICD-10 codes that map to 79 HCC codes in the Risk Adjustment model. CMS requires documentation in the person's medical
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