risk adjustment

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    Wiki HCC mapping effective dates

    Hi all, Can anyone help me to understand the HCC category effective date. Is the effective date is same for Both HCC category value and ICD code effective dates are same i.e. every year Oct 1. or is there any different effective date for HCC codes (Jan 1 or something else.) ? Because there in...
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    Wiki Denials for Unspecified Codes

    Hello, My manager announced to the CDI specialists that CMS will not be paying for unspecified diagnosis codes. I searched to validate this statement and could not find any information. I know claims get denied for laterality frequently. But, she was stating diseases like DM2 unspecified...
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    Wiki Risk Adjustment Policies

    Hello, I work for a health plan as a risk adjustment analyst and our RA program is fairly young. I'm looking to bulk up our policies. Is someone able to provide me sample policies, or at least provide me with a basic list of RA policy subjects? Thanks!
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    Wiki CPC Coder in Jacksonville, FL

    I had an AAPC member help me land my first job in coding with CSI Companies by using this message board and I am extremely appreciative of that member. I have been a Risk Adjustment medical coder with Optum/UNH for the past 8 years. I am interested in pursing a position that pays $60,000+ I...
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    Wiki Back to see if the message board can help me again.

    I had an AAPC member help me land my first job in coding with CSI Companies by using this message board and I am extremely appreciative of that member. I have been a Risk Adjustment medical coder with Optum/UNH for the past 8 years. I am interested in pursing a position that pays $60,000+ I...
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    Wiki Telehealth and Risk Adjustment Validation

    Debating the interpretation of the CMS telehealth video requirement to validate HCC conditions. This (quote below), to my knowledge, has been interpreted as the video needing to be enabled for the entirety of the visit. Thoughts? Do we have guidance or update anywhere that delineates between...
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    Wiki Diabetes 1 and Diabetes 2

    Can we code both diabetes 1 and diabetes 2 if both are mentioned in the assessment and there is MEAT for both in the medical report. Thanks in advance for any help/advice.
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    Wiki Diabetes with CKD and hypertension

    If diabetes with CKD and hypertension is documented, should we code E11.22, N18 series, and I10 or E11.22, N18 series, and I12 series (I12.9/I12.0) Should we take linkage of CKD with diabetes and CKD with hypertension both or only linkage of CKD and diabetes? Thanks in advance for any help/advice.
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    Wiki Clearinghouse limiting # of Diags on a claim! Help

    Hi all, I am running into an issue with a Practice I work with. They are stating that their Clearinghouse is only allowing 4 ICD10 Diagnosis codes to be submitted on a claim, despite them adding the additional diagnosis on the Medicare form appropriately. Now I know that on the electronic...
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    Wiki CP/NSTEMI and 3V CAD

    Per the Hospital notes CP/NSTEMI-on Heparin and 3v CAD is noted with planned CABG, DO I code both NSTEMI I214 and CAD I25.10 or is NSEMI not confirmed diagnosis since it is noted as CP(chest pain)/(slash) NSTEMI. Thank you
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    Wiki Senior Manager, Risk Adjustment Provider Education & CDI Program Development & Implementation

    Nicole Martin has been working in the healthcare industry for 20+ years. She has held a broad variety of positions including, multi-specialty & surgical coding of professional services for 10 years, Manager, Medical Practice Management section for The Medical Society of New Jersey, Compliance...
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    Wiki HHS Risk Adjustment Education

    Good morning, I am wondering who else out there might have any commercial risk adjustment education for providers? I have been going on to physicians offices as well as meeting with coding and billing staff to give presentations regarding HHS Risk Adjustment. I am looking to add information...
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    Wiki Questions for a newbee! Location: Georiga

    Hello Everyone! I am switching careers from public safety to CRC. From what I am learning I am confident that my skills are very much transferable and will really help me in this new line of work it is just a matter of getting the experience. I am beginning a online course shortly and am...
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    Wiki Coding with MEAT or not

    I have been doing RA coding for insurance companies for 4 years now. When I was originally trained, I was told to look for MEAT or TAMPER for every RA code before submitting to CMS. However, CMS also says to follow ICD 10 guidelines. In the 2017 ICD 10 guidelines, this statement was added...
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    Wiki Uncontrolled Diabetes in ICD10-Coding Clinic

    Hello All. Having this discussion with a coding vendor and there is some confusion. When ICD-10 came out a big change was that Uncontrolled Diabetes was coded as E1165 Diabetes with hyperglycemia rather than E119. This Coding Clinic determination was pointed out to me and I'm having a hard time...
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    Wiki General Chart Review Question

    Hello all. I am a new AAPC member working on my CRC certification. I work for a start up health plan in NYC and we are working on conducting our first round of chart reviews for risk adjustment. If a health plan has medical records and identifies discrepancies in their HCCs (assuming the...
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    Wiki CHDS, CPC-A, COC-A, CRC - Seeking Remote HCC Coding Position

    I would love to join your team of remote HCC coders and am confident I will do an outstanding job. Thank you for your consideration. PAMELA S. HEBERT, CHDS, CPC-A, COC-A, CRC www.linkedin.com/in/pamela-s-hebert SUMMARY Responsible and dedicated professional with 14 years as a remote...
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    Wiki Anyone looking in the greater Seattle area?

    We have two openinggs at Humana in our Federal Way office for a Medicare Risk Adjustment Provider Educator. This is a great opportunity for a CPC that would like to expand into the world of HCC coding and Risk Adjustment. MRA Provider Educator- Federal Way, WA-157514 Hiring Manager: Harry...
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    Wiki Remote 1099 HCC (Diagnosis Coding) with Training & Laptop Provided

    I am happy to announce that ionHealthcare, a nationally renowned risk adjustment coding company is currently hiring 1099 coders for work from home risk adjustment coding work. ionHealthcare carries a reputation of being one of the best risk adjustment vendors across the country. ionHealthcare...
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    Wiki Risk Adjustment Coding - Inpatient Coding Guidelines

    Hello, Can uncertain diagnosis such as r/o, probable, suspected, questionable etc. be captured for HCC risk adjustment purposes on consults, h&p's, progress notes, in an inpatient setting? My thoughts are no; they can only be captured at the time of discharge on a discharge summary...
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    Wiki Coding for Risk Adjustment (HCCs)

    When pulling diagnosis information for risk adjustment from outpatient/physician notes, there is some confusion whether or not to code diagnoses that are listed in PMH. CMS guidance is vague, at best. Arguments include: - Code everything listed in the PMH because if the doctor put it in PMH the...
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