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4 Medical Coding practices for health care coders and payers in Risk adjustment

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4 Medical Coding practices for health care coders and payers in Risk adjustment

Hierarchical Condition Categories (HCCs) and ICD-10-CM codes risk adjustment solution is becoming a trending topic amongst health care payers and medical coders in the United States and worldwide.

With many transitioning to value-based care Medicare Advantage plans, it is more than ever important for medical coders and health care payers to ensure risk adjustment documentation and coding practices are performed as per code abstraction guidelines.

Every health care payer that has Medicare patients who receive coverage and benefits through the Medicare Advantage program uses HCC coding.

Centers for Medicare and Medicaid Services established the HCC risk-adjustment model in 2004 is popular amongst health care payers to process reimbursement claims.

Firstly, let’s take a look at key challenges to medical coders, and payers for risk adjustment score calculation

  • Multiple tools and sources to manage multiple medical coding review tasks
  • Missing those necessary diagnosis codes for risk score derivation
  • Lengthy chart review and chart audit workflow (First level and second level review)
  • Lack of modern tools to measure coder’s productivity.

What are the four HCC coding best practices for Risk Adjustment Factors (RAF) score?

1. NLP Powered AI-Enabled HCC Risk Adjustment Coding Solution

Transitioning from traditional workflow to a modern natural language processing (NLP) powered risk adjustment solution will ensure you a user-friendly, real-time dashboard for identifying and updating accurate HCC codes on the go. In addition, the best risk adjustment model for Value-Based Care is helping healthcare payers improve accuracy by reducing administration costs by eliminating the dependency on multiple vendors.

2. Quick access to HCC and ICD-10-CM codebooks

HCC Risk Adjustment coding solution with an in-built reference for HCC coding guidelines, and integrated codebooks, ensure that you will not miss out on any HCC diagnosis codes while performing medical chart review tasks. A great add-on for medical coders who can gain access to multiple medical chart coding needs under one roof, from anywhere, anytime.

3. Streamlined chart review workflow

Of the many risk adjustment models, the ones that result in fewer chart retrieval requests are highly efficient. A comprehensive AI-Based HCC Risk Adjustment coding solution allows a three-click chart review workflow, all in an effort to improve HCC coding and RAF scores calculation.

4. Real-time Analytics

Last but not least, is the HCC coding Risk Adjustment model that offers real-time analytics of your coder’s productivity. This way, you can ensure who is performing what and take measures on the go to ensure more chart reviews are done using less time.

Ending note

RAAPID.AI allows the above features and is already helping health care payers and medical coders in the US to lower abrasion and increase the efficiency of each HCC coding patient chart review.


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Disclaimer: All the information, views, and opinions expressed in this blog are inspired by Healthcare IT industry trends, guidelines, and their respective web sources and are aligned with the technology innovation, products, and solutions that RAAPID offers to the Risk adjustment market space in the US.