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Risk Adjustment Documentation & Coding

Risk Adjustment Documentation & Coding

Publisher: American Medical Association
Softbound,  8½" x 11",  544 pages
ISBN#: 978-1-62202-733-0
Item#: OP287018
Authors: Sheri Poe Bernard, CCS-P, CDEO, CPC, CRC

Risk Adjustment Documentation & Coding

List Price: 74.95
AMA Member: 54.95


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.

Select Risk Adjustment Documentation & Coding: eBook (Non-printable) 74.95 54.95

Risk Adjustment Documentation & Coding provides:

  • Risk-adjustment parameters to improve documentation related to severity of illness and chronic diseases.
  • Code abstraction guidelines and best practices recommendations 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.

Take a look inside the book.

  • Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, an alphabetized, topical review of clinical documentation improvement and coding for risk-adjustment, and guidance for development of internal risk-adjustment coding policies.
  • Three appendices offering mappings, tabular information, and documentation and abstraction training tools for coders and physicians that include an alphanumeric mapping of ICD-10-CM codes that risk-adjust to HCCs and RxHCCs for Medicare Advantage plans.
  • 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 coding and documentation advice from federal regulatory sources
    • “Sidebars” that provide derivative story and additional information
    • “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 exercises, 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.

From James S. Kennedy, MD, CCS, CCDS, CDIP, author of the book’s foreword:

“As a physician since 1979 and an AHIMA-certified coder since 2001, I attest that Risk Adjustment Documentation & Coding, will be more important than Harrison’s Textbook of Internal Medicine, Sabiston’s Textbook of Surgery, or other fundamental clinical texts as your practice navigates the…waters of ICD-10-CM coding compliance. Sheri Poe Bernard, an accomplished writer and certified coder well versed in ICD-10-CM conventions, successfully outlines many of our documentation and ICD-10-CM coding risks and opportunities essential to the hierarchical condition categories (HCC) RA model CMS uses in judging our cost efficiency. She holds us accountable for how we define, diagnose, document, and deploy ICD-10-CM–based terminology in our medical records.

I strongly urge you and your practice to embrace what Ms. Bernard has written and to develop documentation and coding policies, procedures, infrastructure, and practices implementing her suggestions. Not only will you have a better chance at avoiding an unintended penalty with the MACRA/MIPS/APM models, your practice will have better odds surviving an unwelcome RADV or Department of Justice inquiry into your billing workflow.”

From Robin Linker, CHCA, CHCAS, CPC-I, CPC, COC (CPC-H), CPC-P, MCS-P, CHC, Executive Director of Operations at the Association of Health Care Auditors and Educators:

Risk Adjustment Documentation and Coding provides tools and insights to help guide the reader through this still ominous part of healthcare reimbursement.

The Association of Health Care Auditors and Educators (AHCAE) reviewed and studied this book and we appreciate the smart and thoughtful approach the book takes to make the subject…less oblique for the average clinician, coder, auditor and administrator. If you want to better understand not only the basics of RA coding but also how to improve documentation for optimization of this system, you'll want to keep this book on your shelf for easy access and remember to use it as a teaching companion for coders and clinicians. We highly recommend this resource as adjunct preparation for the AHCAE's Certified Health Care Risk Auditor certification exam and will use it within our Risk Adjustment training programs.”


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