Risk Adjustment (RA) Coding
Risk adjustment (RA) is a method used in which payments are adjusted based on demographic information and patients health status by using Hierarchical Condition Category (HCC) coding as a payment model that identify individuals with serious or chronic illness and assigns a risk factor score for a total year which mandated by Centers for Medicare and Medicaid Services (CMS) and is identified via International Classification of Diseases – 10 (ICD –10) diagnoses that are submitted by providers on incoming claims.
HIA offers Medicare risk adjustment coding (MRA) services for healthcare providers as we provide:
- Complete medical record documentation according to Hierarchical Condition Categories (HCCs) guidelines
- Accurate diagnostic coding that will help you obtain timely reimbursement
- Available Coders proficient in ICD-10 medical coding
- Identifies any missing information in patient records that may not pass a CMS audit
- Review document according to the M.E.A.T. principles
- Provide retrospective audits from current timeframe or to one year look-back
- Confirm all risk adjusted diagnosis codes from acceptable provider documentation and in accordance with industry standards for coding and reporting
Risk Adjustment Factors (RAF) are used by HCC to determine the cost of payments with reimbursement rates based on the patient diagnostic record, captures complex health conditions, and renew HCC scores annually.
HIA recognizes how documentation issues affect both the revenue opportunities and the compliance concerns and we have created a method to ensure audit charts and findings are appropriately addressed to increase provider revenue and while you focus on your patients quality care.
