2023 AC - Risk Based Coding and Value-Based Coding / Biller Education

Maxine Lewis, CMM, CPC, CPC-I, CPMA, CCS-P, Medical Coding & Reimbursement Management Specialized Knowledge Risk adjustment coding requires health plan management, provider group management, physicians, non-physician providers, and highly skilled coding professionals to work together to capture the health status of their patient membership. Risk adjustment is critical to ensuring adequate compensation to health insurance plans, so they maintain coverage and access to care for beneficiaries likely to incur higher than average costs. Because risk adjustment programs are developed and managed by government agencies created to serve all eligible members of the public, a health insurance company cannot discriminate or purposely insure only a certain demographic of members with a limited range of expected healthcare costs. The case mix of both healthy and sicker patients, and the cost-sharing of expenses spread across all members, is designed to provide access to quality healthcare regardless of health status and history. Specificity is the key for utilizing Risk Based Coding and correct coding makes a significant impact on every practice.