CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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Coding Guide – Risk Adjusted Diagnosis Coding for Medical Practices

Risk Adjusted Diagnosis Coding

Payment systems and reimbursements are ever-changing in healthcare and the rules of yesterday may or may not work tomorrow. This 24 page guide from CodingIntel is an introduction to risk adjustment coding and the risk adjustment factor (RAF).

After reading this guide, clinicians will be able to focus on the specificity in diagnosis coding that not only gets a claim paid but also communicates to payers the acuity of their patient population. Managers, coders and billers will find this a helpful introduction to the concept of Risk Adjustment and Hierarchical Condition Category (HCC) coding. 

This guide is essential for any practice that is thinking of joining an ACO or has diagnosis risk adjusted based contracts. Updated for 2018.

For additional information, see the CodingIntel Guide to Hierarchical Condition Categories. It provides a comprehensive list of HCC and Risk Adjusted Diagnosis Coding resources available on CodingIntel.

 

Table of Contents

Purpose
Fee-for-service
What is risk adjustment
Coding and reporting guidelines
HCCs
Examples
Status Codes
Reference

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Additional resources

The CodingIntel Guide to Hierarchical Condition Categories provides a comprehensive list of HCC and Risk Adjusted Diagnosis Coding resources available on CodingIntel.

 

Last revised October 12, 2020 - Betsy
Tags: HCC, ICD-10, primary care, risk adjusted coding

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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