Our Risk Adjustment Coding Consultants are here to help you understand the different levels of the CMS Hierarchical Condition Categories model. We’re also here to help you think about the effects of choosing the best code for your patient’s health conditions, and to help you document that to the highest level of specificity available to you.
HIPPA requires we all follow the ICD (International Classification of Diseases) coding guidelines, which includes choosing the right, compliant, codes and how to support the codes you reported in your documentation. The health care system and patients count on the providers to help show medical necessity through these.
Health plans like us are reimbursed based on the codes providers submit on claims. These codes need to be reported to the highest level of specificity possible to make sure those payments are correct. This is also important in case of an audit that compares the codes to the documentation. This system counts on you to help keep risk low by coding correctly.
Quality of Care
Medicare evaluates plans based on a 5-Star Rating System. The codes reported and supported on the provider level directly relate to this scale. This system counts on the provider to give members peace of mind that Heath Alliance Medicare can provide coverage for the quality care you provide.
Email us with coding questions, comments, or concerns at CodingCounts@healthalliance.org.