Transcription of Risk Adjustment Coding and HCC Guide
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Risk Adjustment Coding and HCC Guide
Power up your Adjustment Coding and HCC Guide2018 Optum360, LLCiContentsIntroduction .. 1 History and purpose of RAF ..1 Key Terms Definitions ..3 Acceptable provider types/SOS ..5 The provider s role ..6 Payment Methodology ..8 RAF Payment Timeline ..12 Coding and Documentation ..15 Explanation of impact of good documentation (table example).. 15 CMS 20 Coding Guidelines .. 44 Tools (MEAT/TAMPER) .. 48 Coding Scenarios/Examples/Teaching .. 59 Audits .. 79 Medicare Advantage Risk Adjustment Data Validation (RADV) .. 79 Health Effectiveness Data & Information Set (HEDIS) .. 87 Internal Care and Quality Improvement Audits ..91 Care and Quality Improvement Audits .. 91 Appendixes - Includes HCC with description, hierarchies, and ICD-10 Mappings .. 103 CMS HCCs .. 105Rx HCCs .. 395 PACE .. 445 HHS-HCC.
HCC 22 E66.2 Obesity hypoventilation syndrome (OHS) 0.273 No Yes Demographics 54-year-old, female, not Medicaid eligible 0.263 Yes Yes Total RAF 0.409 1.077 It is necessary to query the provider for additional information about the depression. There is insufficient documentation to code major depressive disorder.
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