The Centers for Medicare and Medicaid Services (CMS) uses risk adjustment diagnosis codes and demographic data reported for one year to determine payment for the next year. Healthcare providers that participate in Medicare insurance plans must submit accurate diagnosis codes during the risk adjustment period. A reliable medical coding company based in Tulsa, Oklahoma, Outsource Strategies International (OSI) can help medical practitioners meet their MRA/HCC coding data submission deadlines.
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Medicare Risk Adjustment Coding
Our medical coders can provide comprehensive and MRA coding for all kinds of active diagnoses, status conditions and previous illnesses documented.
Medicare risk adjustment enables health plans to be paid appropriately based upon members’ overall health. It classifies patient sickness using HCC (hierarchical condition categories) which are groups of related diagnosis codes. Individual patients may fall into multiple hierarchical codes. For each additional Code, the MA plan is paid an extra amount.
Patient health risks are adjusted using a number of variables, including age, gender, previous health history, and the presence of chronic conditions. This formula yields a member risk score, which is used in calculating payment to a health plan. Physicians should ensure that their patient charts are thorough by documenting all necessary details.
HCC Coding Services
Accurate coding ensures precise risk assessment and helps to submit accurate and complete claims within the risk adjustment period. Our AAPC-certified medical coders, with their knowledge of various codes and the validation process and experience with insurance and governmental regulatory requirements can provide complete medical record documentation and accurate diagnostic coding, resulting in timely reimbursement.
HCC codes are determined based on the five sources accepted by CMS, such as:
- Secondary hospital inpatient
- Hospital outpatient
- Clinically trained non-physician
Save 30 to 40% of your total operation costs with our accurate and efficient HCC and risk adjustment coding services.
What Makes OSI Different?
- Fast, comprehensive record retrieval
- Experienced coding process
- Detailed audit trail
- Quick turnaround time
To benefit from our comprehensive services, you can also send an email to email@example.com.