Risk Adjustment Documentation & Coding, 2nd Edition, (Paperback)

Capturing risk in medical documentation and coding successfully gives a complete and accurate picture of your patients' health; but it is also critical for ensuring proper reimbursement, managing cost, projecting future resource requirements and delivering high-quality care.

Chronic diseases are not outliers, especially in older patients. 80% percent of older adults have at least one chronic condition. If you have any Medicare patients with chronic conditions and if you are participating in Merit-based Incentive Payment Systems (MIPS), the AMA's Risk Adjustment, Documentation and Coding 2e (RA, 2e) will help you capture the care rendered so the severity of your patients' illnesses is adequately captured to reflect your utilization. If you omit risk-adjusting diagnoses because a specialist is managing the care of your patient's chronic condition, you are hurting your MIPS efficiency rating. Most chronic conditions will impact the overall health of the patient; therefore, they are appropriate to capture for your documentation.

In a value and outcome-based health care environment, lack of specificity in ICD-10-CM coding and documentation has ripple effects for a practice and its patients, like - loss of important data and financial returns and increased patient risk. Continuity of care and a complete picture of a patient's overall health are key to quality care. Connecting diagnosis with comorbidities (causes) with ICD-10-CM codes (such as hypertension with heart disease or diabetes and hyperlipidemia with diabetes, etc.) for patients with chronic conditions helps improve care and documentation. RA, 2e, covers this in detail and can help you document your patient's health and wellbeing, and help you get the right reimbursement, especially for your high-risk patients.

Use Risk Adjustment Documentation & Coding, 2nd Edition, to:

• Improve documentation in general and in relation to severity of illness and chronic diseases with risk adjustment parameters.
• Code more accurately with expert guidelines and recommendations.
• Connect diagnosis with comorbidities (cause) with the checklists in the teaching/training tools for the 10 most common chronic diseases.

The impact of risk-adjustment coding (hierarchical condition category (HCC) coding) on a practice is significant because:

• More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States.
• Insurance risk pools under the Affordable Care Act include risk adjustment.
• CMS, which disbursed more than $900 million in MIPS bonuses for 2020, is tightening requirements for these bonuses, and has also proposed expanding audits on risk-adjustment coding.

FEATURES AND BENEFITS

• Five chapters delivering an overview of risk adjustment, common administrative errors, best practices and guidance for development of internal risk-adjustment coding policies, which are organized by diagnoses topic (diabetes, dementia, ischemic heart, etc). Each topic has separate guidance for documentation and for coding.
• 10 ICD-10-CM teaching/training tools for the top-10 most-common chronic diseases to help wi