What to Know About HCC Risk Adjustment, Risk Adjustment
ICD-10 and the RAF Score
In fee-for-service medicine, physician services are paid based on the fee associated with that CPT code, HCPCS code and modifiers. The diagnosis coding establishes the medical necessity for this service. With new payment models, diagnosis coding for physician services takes on added importance. In this presentation from CodingIntel, we discuss the importance of HCC risk adjustment, the RAF score and proper risk adjustment ICD-10 codes.
Accurate and complete diagnosis coding will affect incentive payments and negative payment adjustments along with utilization, quality measures and patient satisfaction. Medical practices joining accountable care organizations, Medicare shared savings programs or entering into diagnosis risk-adjusted contracts with private payers need to review their diagnosis coding and many will need to make changes.
This presentation provides an overview for medical practices in the important concepts related to risk-adjusted diagnosis coding. As our healthcare system moves from volume to value, accurately reporting the severity of illness for individual patience becomes imperative.
Agenda for this webinar includes:
- How physician services are paid
- HCC risk adjustment factors (RAF)
- Common risk adjustment ICD-10 codes
- RAF score
- Demonstrate knowledge of two key concepts of risk-adjusted diagnosis coding
- Evaluate their own risk adjustment ICD-10 use of unspecified codes and use of status codes
- Develop a plan to increase specificity in both primary care and specialty claims
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*This program has the prior approval of AAPC for 1 continuing education credits. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.