Risk Adjustment/Coding Toolkit

NOTE: You must login to your Alliance account to access the articles and resources below. Some content may only be accessible to Alliance members.

 

5/24/2021

Pre-Work Packet: Coding Work Group 2021, Session 3: IU Health Plan
Collaborate with your Alliance peers on risk adjustment coding best practices. During each session, you'll review a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

5/21/2021

Recording: Risk Adjustment Roundtable: CON-14 and CON-15 RADV Audit
Hear Alliance member health plans that participated in the CON-14 and CON-15 RADV Audits share their results, status updates and lessons learned. Bring your questions and come prepared to share your health plan’s RADV best practices.

5/10/2021

Intervention Tracker
Spreadsheet for risk adjustment intervention tracking. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

5/10/2021

Intervention KPIs
Spreadsheet for risk adjustment intervention KPIs. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

5/10/2021

Intervention Return
Spreadsheet for risk adjustment intervention ROI. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

5/10/2021

Recording: Risk Adjustment Roundtable: Key Performance Metrics
Curious what risk adjustment key performance indicators other health plans are using? Alliance members recently shared a number of ideas on the discussion forum. During this call, we’ll go deeper. Dean Ratzlaff, actuary at Sentara Health Plans (Optima), will elaborate on their approach, then we’ll open up the line and the chat for open discussion.

5/6/2021

Nested Egg Model of Risk Score Accuracy
Provides a visual aid for explaining that there are several layers to a member's risk score. There is the member's actual medical complexity, what's documented, what's coded and then what's accepted by CMS for aged and disabled, dual eligibles and members with End Stage Renal Disease (ESRD). Drawing by Dean Ratzlaff, Actuary, Sentara Health Plans (Optima) at an Alliance Risk Adjustment at an in-person meeting converted into a PowerPoint slide by the IU Health team.

5/3/2021

Recording: Coding Work Group 2021, Session 2: Paramount Health Care
The Paramount Health Care team reviews a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

5/3/2021

Pre-Discussion Survey Results: Coding Work Group 2021, Session 2: Paramount Health Care
The Paramount Health Care team reviews a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

5/2/2021

Chat Transcript: Coding Work Group 2021, Session 2: Paramount Health Care
The Paramount Health Care team reviews a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

4/15/2021

Pre-Work Packet: Coding Work Group 2021, Session 2: Paramount Health Care
The Paramount Health Care team reviews a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

4/5/2021

Recording: To Code or Not to Code?
As part of the Risk Adjustment & Quality Learning Collaborative, Centauri Health Solutions leads a review of the official guidelines for coding and reporting. Best practices for appropriate diagnosis code capture and then practice applying the guidelines to documentation examples are covered.

4/1/2021

Recording: Coding Work Group 2021: Session 1 - Providence Health Plan
Collaborate with your Alliance peers on risk adjustment coding best practices. Review of five to six guidelines that give coders trouble (like coding BMI/obesity as an example) and invite participants to ask questions and share their best practices are covered.

4/1/2021

Presentation: To Code or Not to Code?
As part of the Risk Adjustment & Quality Learning Collaborative, Centauri Health Solutions leads a review of the official guidelines for coding and reporting. Best practices for appropriate diagnosis code capture and then practice applying the guidelines to documentation examples are covered.

3/30/2021

Presentation: The Risk Adjustment Jacobian and Natural Language Processing
Tessellate discusses the risk adjustment jacobian, NLP, and compliance guidelines.

3/30/2021

Medicare Benefit Policy Manual Chapter 10-Ambulance Services
Paramount Health Care provides Alliance members with the policy to follow for Medicare Benefit Policy Manual Chapter 10- Ambulance Services, to pay for covered ambulance procedures used for emergency transportation as reported by the provider of service.

3/22/2021

Discussion Packet: Coding Work Group 2021: Session 1 - Providence Health Plan
Collaborate with your Alliance peers on risk adjustment coding best practices. During this session, we'll review five to six guidelines that give coders trouble (like coding BMI/obesity as an example) and invite participants to ask questions and share their best practices.

3/8/2021

Recording: All about Hormones: Correctly documenting and coding for Endocrine Disorders
This session is one in a series focused on delivering educational risk adjustment coding content. As part of the Risk Adjustment & Quality Learning Collaborative, Diane Escandell will focus on assisting coders in making appropriate decisions when it comes to coding particularly challenging documentation, provide updates on new diagnostic codes and HCC model updates, or discuss documentation that was accepted or not accepted by CMS.

3/4/2021

Presentation: All about Hormones: Correctly documenting and coding for Endocrine Disorders
This session is one in a series focused on delivering educational risk adjustment coding content. As part of the Risk Adjustment & Quality Learning Collaborative, Diane Escandell will focus on assisting coders in making appropriate decisions when it comes to coding particularly challenging documentation, provide updates on new diagnostic codes and HCC model updates, or discuss documentation that was accepted or not accepted by CMS.

2/28/2021

Recording: Doubling Down: Dual HHS-RADV Audits
This year, we’ll be managing dual RADV audits. As part of the Risk Adjustment & Quality Learning Collaborative, Centauri Health Solutions reviews the HHS-RADV activities calendar, the challenges, and best practices for managing different coding rules by benefit year.