Providers under value-based care are reimbursed for quality care, not more care. Patients suffering from critical conditions need more sensitive care than patients who are usually healthy. Risk adjustment is a vital component of medical billing that focuses on maintaining that health plans and providers get appropriate payment for the sake of services they have rendered to the patients.
Gathering full-fledged demographic and diagnostic data for each patient through proper HCC risk adjustment coding is highly effective in value-based care models. This is where the support of skilled and professional medical billing and coding companies can be great companions for physicians.
Why is risk adjustment important?
The switch from fee-for-service to value-based care is transforming how patients are cared for and how providers are compensated for performance. Risk adjustment is essential for health plans and patients delivering care for high-risk patients.
The fluctuations in the health condition of patients can essentially affect the cost of providing care. For example, patients with severe diabetes or heart disease need more sensitive care and treatment. Risk adjustment judges each patient’s health condition, medical history, and other factors to determine the estimated cost of care for a particular patient. This proves risk adjustment is critical for both health plans and providers:
How can physicians benefit from risk adjustment?
Error-free HCC coding is critical to highlight patient complexity and frame the scenario of the whole patient for risk adjustment. This way, they can obtain the proper reimbursement for serving critical patients. Providers should keep active diagnoses, including chronic conditions, annually.
Physicians should keep a track record of complete and accurate documentation of patient conditions. This helps in supporting both risk adjustment and quality reporting initiatives. All necessary clinical data should be clearly stated, including diagnoses, medical history, and treatment plans. Sorted documentation is critical to accurately collect a patient’s proper status of disease severity or risk using HCC codes. It also ensures that the services provided are appropriately reimbursed.
The most vital element of HCC coding is assessing health record documentation to gain reportable conditions and assigning the correct ICD-10 codes to reflect them. Risk adjustment documentation best practices suggested by AHIMA include: