Risk Adjustment/Coding Toolkit
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Recording: Coding work group Health Alliance Medical Plans
Health Alliance Medical Plan has compiled multiple case studies for discussion during the July 2016 coding work group session
Health Alliance Medical Plan Coding Work group materials July 2016
Health Alliance Medical Plan has compiled multiple case studies for discussion during the July 2016 coding work group session
Coding Reviewer
Perform onsite or electronic audits of medical records/claims to ensure proper medical diagnoses are being submitted for reimbursement. Responsible for the validation of existing diagnosis codes as well as the identification of missing diagnosis codes not submitted on the claim.
Recording: Coding work group case study collection form SelectHealth June 2016
SelectHealth case study for the coding work group
Feedback Tool SOP_Health New England
This document outlines our standard operating procedure for our Chart Review Feedback tool. Also included are examples of the template Engagement letter that is sent to practices at the beginning of the review, Exit letter informing them that the review is complete, and examples of the tools attached to the Feedback summary that provides them with information around our findings.
Coding work group case study collection form SelectHealth June 2016
This collection from SelectHealth is the coding work group case study pre-work from the June 2016 work group meeting.
recap: Coding work group April 28
The Health New England team compiled take aways from our April 28 webinar for the Alliance Coding Work Group
Coding work group case study chronic condition in routine exam
It is argued that, according to ICD guidelines, providers should not bill for chronic conditions at routine examinations, even if addressed.
Coding work group case study prostate cancer current vs history
These two "problem charts" have been submitted by Health New England for consideration by the Alliance coding work group, and address the issue of coding cancer current vs. history.
Alliance coding work group: proposed approach
Alliance members met in March 2016 to discuss a potential approach to forming a coding work group, which would support certified coders within member health plans. This document outlines that proposed approach.
Initial idea: Coding work group for the Health Plan Alliance
Jessica Dupont made the initial pitch for our coding work group. Listen to her description of what the group could do for our Alliance members.
Coding Specialist
Perform onsite or electronic audits of medical records/claims to ensure proper medical diagnoses are being submitted for reimbursement. Responsible for the validation of diagnosis codes as well as the identification of missing diagnoses codes submitted on the claim and more.
Risk Adjustment Quality Assurance and Compliance Procedure Manual
To ensure quality submission of HCC codes to the Center for Medicare & Medicaid Services (CMS) by auditing prospective and retrospective chart reviews.
CMS Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance - September 2017
The Contract-Level Risk Adjustment Data Validation (RADV) Medical Record Reviewer Guidance has been created to provide information on the RADV medical record process. These guidelines are used by coders to evaluate the medical records submitted by plans to validate audited diagnoses.