The Provider's Role in Risk Coding

Posted by Continuum on Jun 19, 2018 11:32:00 AM

Physicians must code diagnoses properly to succeed under Medicare Advantage & other value-based contracts 

Each year, CMS sets cost benchmarks for every Medicare Advantage member, based on the patients’ diagnoses during the prior year. But what if the physician hasn’t reported their patients’ health information accurately or fully? The result is often benchmarks that are set too low, and costs of care exceeding benchmarks.

The payer then thinks the doctor spent too much on members’ care, and does not recognize or reward the value (high quality/lower cost) of the care provided by the physician. 

That's why proper Medicare Risk coding—entering diagnosis codes in the EMR and on claims—is essential. Providers who follow best practices for risk coding have a better chance of earning shared savings. 

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Topics: coding, icd-10, value-based care, Medicare Advantage, risk adjustment, risk coding, risk scoring

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