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Author: Sheri Poe Bernard
Publisher: American Medical Association Press
ISBN: 9781622027330
Category : Chronic diseases
Languages : en
Pages : 0
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Book Description
Risk-adjustment practices consider chronic diseases as predictors of future healthcare needs and expenses. Detailed documentation and compliant diagnosis coding are critical for proper risk adjustment. Risk Adjustment Documentation & Coding provides: - Risk adjustment parameters to improve documentation related to severity of illness and chronic diseases. - Code abstraction designed to improve diagnostic coding accuracy without causing financial harm to the practice or health facility. The impact of risk adjustment coding--also called hierarchical condition category (HCC) coding--on a practice should not be underestimated: - More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States. - Insurance risk pools under the Affordable Care Act include risk adjustment. - CMS has proposed expanding audits on risk adjustment coding. Meticulous diagnostic documentation and coding is key to accurate risk-adjustment reporting. This book will help align the industry though an objective compilation and presentation of risk adjustment documentation and coding issues, guidance, and federal resources. Features and Benefits - Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, topical review of clinical documentation improvement and coding for risk adjustment alphabetized by HCC group, and guidance for development of internal risk adjustment coding policies. - Six appendices offering mappings, tabular information, and training tools for coders and physicians that include an alphanumeric mapping of ICD-10-CM codes to HCCs and RxHCCs and information about Health and Human Services HCCs versus Medicare Advantage HCCs. - Learning and design features: - Vocabulary terms highlighted within the text and conveniently defined at the bottom of the page. - "Advice/Alert Notes" that highlight important advice from the ICD-10-CM Guidelines for Coding and Reporting. - "Key Coding Concepts" that offer the advice published in ICD-10-CM Coding Clinic for ICD-10-CM and ICD-10-PCS. - "Sidebars" that detail measurements pertinent to risk adjustment seen in physician documentation, eg., cancer staging, disability status, or GFRs. - "Coding Tips" that guide coders to the right answers (using terminology and ICD-10-CM Index and Tabular entries) or provide cautionary notes about conflicts in the official ICD-10-CM guidance. - "Clinical Examples" that underscore key documentation issues for risk adjustment. - Clinical coding examples that provide snippets or full encounter notes and codes to illustrate key issues for the HCC or RxHCC. - "Documentation tips" highlight recommendations to physicians regarding what should be included in the medical record or how ICD-10-CM may classify specific terms. - "Examples" that explain difficult concepts and promote understanding of those concepts as they relate to a section. - "FYI" call outs that provide quick facts. - Extensive end-of-chapter "Evaluate Your Understanding" sections that include multiple-choice questions, true-or-false questions, and Internet-based exercises. - Downloadable slide presentations for each chapter that cover key content and concepts. - Exclusive content for academic educators: A test bank containing 100 questions and a mock risk-adjustment certification exam with 150 questions
Author: Sheri Poe Bernard
Publisher: American Medical Association Press
ISBN: 9781622027330
Category : Chronic diseases
Languages : en
Pages : 0
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Book Description
Risk-adjustment practices consider chronic diseases as predictors of future healthcare needs and expenses. Detailed documentation and compliant diagnosis coding are critical for proper risk adjustment. Risk Adjustment Documentation & Coding provides: - Risk adjustment parameters to improve documentation related to severity of illness and chronic diseases. - Code abstraction designed to improve diagnostic coding accuracy without causing financial harm to the practice or health facility. The impact of risk adjustment coding--also called hierarchical condition category (HCC) coding--on a practice should not be underestimated: - More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States. - Insurance risk pools under the Affordable Care Act include risk adjustment. - CMS has proposed expanding audits on risk adjustment coding. Meticulous diagnostic documentation and coding is key to accurate risk-adjustment reporting. This book will help align the industry though an objective compilation and presentation of risk adjustment documentation and coding issues, guidance, and federal resources. Features and Benefits - Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, topical review of clinical documentation improvement and coding for risk adjustment alphabetized by HCC group, and guidance for development of internal risk adjustment coding policies. - Six appendices offering mappings, tabular information, and training tools for coders and physicians that include an alphanumeric mapping of ICD-10-CM codes to HCCs and RxHCCs and information about Health and Human Services HCCs versus Medicare Advantage HCCs. - Learning and design features: - Vocabulary terms highlighted within the text and conveniently defined at the bottom of the page. - "Advice/Alert Notes" that highlight important advice from the ICD-10-CM Guidelines for Coding and Reporting. - "Key Coding Concepts" that offer the advice published in ICD-10-CM Coding Clinic for ICD-10-CM and ICD-10-PCS. - "Sidebars" that detail measurements pertinent to risk adjustment seen in physician documentation, eg., cancer staging, disability status, or GFRs. - "Coding Tips" that guide coders to the right answers (using terminology and ICD-10-CM Index and Tabular entries) or provide cautionary notes about conflicts in the official ICD-10-CM guidance. - "Clinical Examples" that underscore key documentation issues for risk adjustment. - Clinical coding examples that provide snippets or full encounter notes and codes to illustrate key issues for the HCC or RxHCC. - "Documentation tips" highlight recommendations to physicians regarding what should be included in the medical record or how ICD-10-CM may classify specific terms. - "Examples" that explain difficult concepts and promote understanding of those concepts as they relate to a section. - "FYI" call outs that provide quick facts. - Extensive end-of-chapter "Evaluate Your Understanding" sections that include multiple-choice questions, true-or-false questions, and Internet-based exercises. - Downloadable slide presentations for each chapter that cover key content and concepts. - Exclusive content for academic educators: A test bank containing 100 questions and a mock risk-adjustment certification exam with 150 questions
Author: Sheri Poe Bernard
Publisher: American Medical Association Press
ISBN: 9781640160392
Category :
Languages : en
Pages : 500
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Book Description
Risk-adjustment practices consider chronic diseases as predictors of future health care needs and expenses. Correct and detailed documentation and compliant diagnosis coding are critical for proper risk adjustment. Risk Adjustment Documentation & Coding, 2nd Edition provides: Risk-adjustment parameters to improve documentation related to severity of illness and chronic diseases. Code abstraction guidelines and recommendations to improve diagnostic coding accuracy without causing financial harm to the practice or health facility. Chronic disease ICD-10-CM coding summaries for quick reference and study. The impact of risk-adjustment coding (hierarchical condition category (HCC) coding) on a practice should not be underestimated: More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States. Insurance risk pools under the Affordable Care Act include risk adjustment. CMS has proposed expanding audits on risk-adjustment coding. FEATURES AND BENEFITS Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, and guidance for development of internal risk-adjustment coding policies. Ten chronic disease ICD-10-CM coding summaries for quick reference and study. Two appendices offering mappings and tabular information of ICD-10-CM codes that risk-adjust to HCCs and RxHCCs. Learning and design features: Vocabulary terms highlighted within the text and defined at the bottom of the page. "Advice/Alert Notes" that highlight important coding and documentation advice from federal regulatory sources. "Sidebars" that provide derivative story and additional information, such as "Coding Tips" that guide coders with practical advice from sources like AHA's Coding Clinic and cautionary notes about conflicts and exceptions "Clinical Examples" that underscore key documentation issues for risk adjustment "Clinical Coding Examples" that provide snippets or full encounter notes and codes to illustrate risk-adjustment coding and documentation concepts "Documentation tips" that highlight recommendations to physicians regarding what should be included in the medical record or how ICD-10-CM may classify specific terms "Examples" that explain difficult concepts and promote understanding of those concepts as they relate to a section "FYI" call outs that provide quick facts "Abstract & Code It!" exercises that test diagnosis abstraction and coding skills (exclusive to Chapter 4) Extensive end-of-chapter "Evaluate Your Understanding" sections that include multiple-choice questions, true-or false questions, audit and Internet-based exercises. Two downloadable course tests and slide presentations for each chapter. Exclusive content for academic educators: A test bank containing 100 questions and a mock risk-adjustment certification exam with 150 questions.
Author: Sheri Poe Bernard
Publisher:
ISBN: 9781640160408
Category :
Languages : en
Pages :
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Book Description
"Risk-adjustment (RA) practices consider chronic diseases as predictors of future healthcare needs and expenses. Detailed documentation and compliant diagnosis coding are critical for proper RA. Risk Adjustment Documentation & Coding provides: RA parameters to improve documentation related to severity of illness and chronic diseases. Code abstraction designed to improve diagnostic coding accuracy without causing financial harm to the practice or health facility. The impact of RA coding-also called hierarchical condition category (HCC) coding-on a practice should not be underestimated: More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States. Insurance risk pools under the Affordable Care Act include risk adjustment. CMS has proposed expanding audits on RA coding. Meticulous diagnostic documentation and coding is key to accurate RA reporting. This book will help align the industry through an objective compilation and presentation of RA documentation and coding issues, guidance, and federal resources"--
Author:
Publisher: Optum 360
ISBN: 9781622544554
Category : Medical
Languages : en
Pages :
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Book Description
The Risk Adjustment Coding and HCC Guide brings together hard-to-find information about risk adjustment (RA) coding and hierarchical condition categories (HCCs) in a new comprehensive resource that explains this complex reimbursement methodology. Now your organization will have a guide that provides both the big picture and the fine detail needed to document, code, and report essential information so that accurate risk levels are assigned and appropriate reimbursement received.
Author: Ian G. Duncan
Publisher: ACTEX Publications
ISBN: 1566987695
Category : Business & Economics
Languages : en
Pages : 350
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Book Description
This text is listed on the Course of Reading for SOA Fellowship study in the Group & Health specialty track. Healthcare Risk Adjustment and Predictive Modeling provides a comprehensive guide to healthcare actuaries and other professionals interested in healthcare data analytics, risk adjustment and predictive modeling. The book first introduces the topic with discussions of health risk, available data, clinical identification algorithms for diagnostic grouping and the use of grouper models. The second part of the book presents the concept of data mining and some of the common approaches used by modelers. The third and final section covers a number of predictive modeling and risk adjustment case-studies, with examples from Medicaid, Medicare, disability, depression diagnosis and provider reimbursement, as well as the use of predictive modeling and risk adjustment outside the U.S. For readers who wish to experiment with their own models, the book also provides access to a test dataset.
Author: Department Of Health And Human Services
Publisher: Lulu.com
ISBN: 9781716599989
Category : Medical
Languages : en
Pages : 128
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Book Description
These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.
Author: The Coders Choice LLC
Publisher:
ISBN: 9781698476964
Category :
Languages : en
Pages : 97
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Book Description
A Hierarchical Condition Category (HCC) is defined as a risk adjustment model that is used to calculate risk scores to predict future healthcare costs. The Centers for Medicare and Medicaid Services' (CMS) CMS-HCC model is used to predict healthcare spending for Medicare Advantage Plan enrollees. The purpose of the scoring model is to adjust capitated payments made to beneficiaries in these plans based on the member's health. HCCs were initially implemented by CMS in 2000 and have been phased in over time. This article will focus on the CMS-HCC model.The model is based on diagnosis codes and includes 79 HCCs. Age, sex, disability, and living circumstances--such as whether the individual is living at home, in a nursing home, or in a long-term care facility--also play a part in the calculations of an HCC.
Author: American Medical Association
Publisher:
ISBN: 9781640161559
Category :
Languages : en
Pages : 1250
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Book Description
ICD-10-CM 2022: The Complete Official Codebook provides the entire updated code set for diagnostic coding, organized to make the challenge of accurate coding easier. This codebook is the cornerstone for establishing medical necessity, correct documentation, determining coverage and ensuring appropriate reimbursement. Each of the 22 chapters in the Tabular List of Diseases and Injuries is organized to provide quick and simple navigation to facilitate accurate coding. The book also contains supplementary appendixes including a coding tutorial, pharmacology listings, a list of valid three-character codes and additional information on Z-codes for long-term drug use and Z-codes that can only be used as a principal diagnosis. Official 2022 coding guidelines are included in this codebook. FEATURES AND BENEFITS Full list of code changes. Quickly see the complete list of new, revised, and deleted codes affecting the CY2022 codes, including a conversion table and code changes by specialty. QPP symbol in the tabular section. The symbol identifies diagnosis codes associated with Quality Payment Program (QPP) measures under MACRA. New and updated coding tips. Obtain insight into coding for physician and outpatient settings. Chapter 22 features U-codes and coronavirus disease 2019 (COVID-19) codes Improved icon placement for ease of use New and updated definitions in the tabular listing. Assign codes with confidence based on illustrations and definitions designed to highlight key components of the disease process or injury and provide better understanding of complex diagnostic terms. Intuitive features and format. This edition includes color illustrations and visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, codes associated with CMS hierarchical condition categories (HCC), Medicare Code Edits (MCEs), manifestation codes, other specified codes, and unspecified codes. Placeholder X. This icon alerts the coder to an important ICD-10-CM convention--the use of a "placeholder X" for three-, four- and five-character codes requiring a seventh character extension. Coding guideline explanations and examples. Detailed explanations and examples related to application of the ICD-10-CM chapter guidelines are provided at the beginning of each chapter in the tabular section. Muscle/tendon translation table. This table is used to determine muscle/tendon action (flexor, extensor, other), which is a component of codes for acquired conditions and injuries affecting the muscles and tendons Index to Diseases and Injuries. Shaded guides to show indent levels for subentries. Appendices. Supplement your coding knowledge with information on proper coding practices, risk-adjustment coding, pharmacology, and Z-codes.
Author:
Publisher:
ISBN:
Category : Classification
Languages : en
Pages : 76
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Book Description
Author: Lisa I. Iezzoni
Publisher: Asociation of University Programs in Health Administration/Health Administration Press
ISBN: 9781567934373
Category : Decision making
Languages : en
Pages : 0
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Book Description
This text offers independent chapters for a multidisciplinary readership of students and professionals in areas such as biostatistics, public health, psychology, and health policy. It introduces concepts and methods for designing, using, and evaluating risk adjustment methods when comparing outcomes of care such as costs, clinical outcomes, and patient-centered outcomes in various health care settings. Because the field is broad and changing, the book does not review existing risk adjustment methods; instead, it concentrates on basic methods and principles that apply generally to risk adjustment. Individual chapters are devoted to data from administrative sources, medical records, and patient surveys. Later chapters cover practical issues in developing and evaluating risk adjustment methods and understanding their validity and reliability. There is also material on risk adjustment for specific populations. This fourth edition contains a new chapter on using risk adjustment in the management of health care organizations, plus new information on genetic, social, and environmental risk factors. This edition reflects current practice in electronic health records and health information technologies. Iezzoni teaches medicine at Harvard Medical School. Annotation ©2012 Book News, Inc., Portland, OR (booknews.com).
