Speaker: Betsy Nicoletti
Medical practices joining ACOs (accountable care organizations), Medicare shared savings programs or entering into diagnosis risk-adjusted contracts with private payers need to review their diagnosis coding and many will need to make changes.
In fee-for-service medicine, physician services are paid based on the fee associated with that CPT code, HCPCS code and modifiers. The diagnosis coding establishes the medical necessity for this service. With new payment models, diagnosis coding for physician services takes on added importance. Accurate and complete diagnosis coding will affect incentive payments and negative payment adjustments along with utilization, quality measures and patient satisfaction. Medical practices joining ACOs (accountable care organizations), Medicare shared savings programs or entering into diagnosis risk-adjusted contracts with private payers need to review their diagnosis coding and many will need to make changes.
It is important for physician practices to understand the concepts of risk-adjusted diagnosis coding. Hierarchical Coding Conditions (HCCs) is a common nonproprietary system already in use by Medicare for Medicare advantage and comprehensive primary care + programs. Medical practices need to follow ICD-10 rules when selecting diagnosis codes for an encounter, and know whether to use all current and past conditions. Medical practices should take special care with selecting specific diagnosis codes for chronic conditions and know what types of unspecified codes don’t carry a risk-adjusted factor. Practices often neglect to report status codes and failure to do that has negative consequences in risk-adjusted diagnosis coding.
This webinar provides an overview for medical practices in the important concepts related to risk-adjusted diagnosis coding. As our healthcare system moves from value to volume, accurately reporting the severity of illness for individual patients becomes imperative.
Listen to this webinar to:
- Demonstrate knowledge of two key concepts of risk-adjusted diagnosis coding
- Evaluate their own ICD-10 coding use of unspecified codes and use of status codes
- Develop a plan to increase specificity in both primary care and specialty claims