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Each year, CMS sets cost benchmarks for every Medicare member based on the patients’ demographics and diagnoses during the assessment period. But what if the physician didn’t report their patients’ diagnoses accurately or specifically? The result is often benchmarks that are set appropriately low based on the information provided by the physician, and costs of care that exceed benchmarks. CMS therefore fails to reward the value of the actual care provided. Proper risk adjustment coding—documenting the appropriate diagnosis codes in the EMR and on claims and treating the patient for each diagnosis—is essential. Those practices that follow proven methods for risk adjustment coding improve their chances of helping their ACO, patient population and provider receive appropriate rewards.By the end of this webinar, participants will be able to:
- Understand risk adjustment coding and its importance to ACO performance
- Identify areas of opportunity for improving accurate diagnosis coding within primary care
- Understand how coding activities connect to Hierarchal Classification Categories (HCCs), EHR structure, billing and clearinghouse practices
- Align more effectively with referral providers within the ACO
- Engage patients to create a more accurate picture of the patient and practice population’s health