Transcription of Risk Adjustment Coding and HCC Guide
{{id}} {{{paragraph}}}
Example: biology
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 .. 495 RAF weights tables .. 5352018 Optum360, LLC1 IntroductionThe traditional fee-for-service payment model has been widely used since the 1930s when health insurance plans initially gained popularity within the United States.
using the Hierarchical Condition Category (HCC)/risk adjustment model since 2004. The primary purpose of a risk adjustment model is to predict (on average) the future healthcare costs for specific consortiums enrolled in MA health plans. CMS is then able to provide capitation payments to these private health plans.
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: