Risk Adjustment Coding and Hcc Guide 2020

Risk Adjustment Coding and Hcc Guide 2020
Author: Anonim
Publsiher: Unknown
Total Pages: 135
Release: 2019-11
Genre: Electronic Book
ISBN: 1622546539

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Risk Adjustment Coding and Hcc Guide 2019

Risk Adjustment Coding and Hcc Guide 2019
Author: Anonim
Publsiher: Optum 360
Total Pages: 135
Release: 2018-08-22
Genre: Medical
ISBN: 1622544552

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The Risk Adjustment Coding and HCC Guide brings together hard-to-find information about risk adjustment (RA) coding and hierarchical condition categories (HCCs) in a new comprehensive resource that explains this complex reimbursement methodology. Now your organization will have a guide that provides both the big picture and the fine detail needed to document, code, and report essential information so that accurate risk levels are assigned and appropriate reimbursement received.

Risk Adjustment Factor Raf Made Easy Provider Handbook

Risk Adjustment Factor  Raf  Made Easy  Provider Handbook
Author: Barbara Jane Deaton
Publsiher: Risk Adjustment
Total Pages: 58
Release: 2019-09-11
Genre: Medical
ISBN: 0578575701

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Providers have been counseled to code "to the highest specificity," yet are not taught how to accomplish it. Already overworked and often underpaid the Provider doesn't have time to plow through all the rules and regulations to produce the solution. Risk Adjustment Factor Made Easy hopes to cut through the jungle of red-tape, thick textbooks, and laborious internet searches to equip the Provider with quick access to the knowledge needed to be successful while providing references on topics for more exploration when desired. In this version of the Hierarchical Condition Coding (HCC) and Risk-Adjustment Factor (RAF) coding book, the busy provider will receive a simple short-cut to all the information necessary to be successful. This book is quick; easy-to-understand; focuses on common mistakes made by Providers and displays examples of proper coding with appropriate details to help the Provider describe the illnesses of their patients more effectively.HCC/RAF is designed to estimate a patient's "future" health care costs. With the changing of the payment system for Providers from "Paid for Services Rendered" to "Risk-Adjustment Value-Based Care" adherence to coding guidelines are vital to a Provider's bottom line. With the coding details listed, you will learn which codes carry high value and why the codes currently used are not increasing your risk score; thereby, lowering potential earnings. The business end of the practice often suffers because of simple coding errors. This RAF book will arm the provider with the tools necessary to ensure success in the "Value-Based Care" system. ABOUT THE AUTHOR: Barbara Jane Deaton, MSN, FNP-BC, ENP-BCBarbara holds a Master of Science in Nursing and is dually certified as a Family Nurse Practitioner and an Emergency Nurse Practitioner. She owns her own practice in North Carolina and is deeply involved in Risk Adjustment Factor Coding. She has been recognized by a major insurance agency for her understanding of the Risk Adjustment Factor and its role in the future of medicine. Her own risk score has significantly increased by implementing the rules contained in this book.Barbara has won numerous awards since entering the medical field. Among her awards are "Best Nurse Practitioner Award in Morganton, NC 2018" for Inclusion in the 2019-2020 Edition of Worldwide Leaders in Healthcare: nominated Best Nurse Practitioner Preceptor 2019 by Perdue University: Business of the Year Award in Burke County, NC Foundation Award; and the Emergency Physicians Award by the United States Commerce Association.NOTE FROM THE AUTHOR: Over the past year, as I became more interested in the Risk Adjustment Factor (RAF), I realized that much of my research portrayed RAF as complex and extremely difficult to learn. When I began putting RAF into play in my own practice, I realized that as a Family Provider, the main codes continued to reappear. The techniques developed became second nature. Gifted with the ability to translate complex medical problems into simple language for some of my uneducated patients; I became aware that this gift should be used to break down the barriers that exist with Risk Adjustment Factor Coding. This book is written in a simplified format with characterizations to help get the point across. By placing these techniques into practice, the patient's illnesses will be accurately portrayed, and the Provider's bottom line will improve

Risk Adjustment Documentation and Coding

Risk Adjustment Documentation and Coding
Author: Sheri Poe Bernard
Publsiher: American Medical Association Press
Total Pages: 500
Release: 2020-03-02
Genre: Electronic Book
ISBN: 1640160396

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Risk-adjustment practices consider chronic diseases as predictors of future health care needs and expenses. Correct and detailed documentation and compliant diagnosis coding are critical for proper risk adjustment. Risk Adjustment Documentation & Coding, 2nd Edition provides: Risk-adjustment parameters to improve documentation related to severity of illness and chronic diseases. Code abstraction guidelines and recommendations to improve diagnostic coding accuracy without causing financial harm to the practice or health facility. Chronic disease ICD-10-CM coding summaries for quick reference and study. The impact of risk-adjustment coding (hierarchical condition category (HCC) coding) on a practice should not be underestimated: More than 75 million Americans are enrolled in risk-adjusted insurance plans. This population represents more than 20% of those insured in the United States. Insurance risk pools under the Affordable Care Act include risk adjustment. CMS has proposed expanding audits on risk-adjustment coding. FEATURES AND BENEFITS Five chapters delivering an overview of risk adjustment, common administrative errors, best practices, and guidance for development of internal risk-adjustment coding policies. Ten chronic disease ICD-10-CM coding summaries for quick reference and study. Two appendices offering mappings and tabular information of ICD-10-CM codes that risk-adjust to HCCs and RxHCCs. Learning and design features: Vocabulary terms highlighted within the text and defined at the bottom of the page. "Advice/Alert Notes" that highlight important coding and documentation advice from federal regulatory sources. "Sidebars" that provide derivative story and additional information, such as "Coding Tips" that guide coders with practical advice from sources like AHA's Coding Clinic and cautionary notes about conflicts and exceptions "Clinical Examples" that underscore key documentation issues for risk adjustment "Clinical Coding Examples" that provide snippets or full encounter notes and codes to illustrate risk-adjustment coding and documentation concepts "Documentation tips" that highlight recommendations to physicians regarding what should be included in the medical record or how ICD-10-CM may classify specific terms "Examples" that explain difficult concepts and promote understanding of those concepts as they relate to a section "FYI" call outs that provide quick facts "Abstract & Code It!" exercises that test diagnosis abstraction and coding skills (exclusive to Chapter 4) Extensive end-of-chapter "Evaluate Your Understanding" sections that include multiple-choice questions, true-or false questions, audit and Internet-based exercises. Two downloadable course tests and slide presentations for each chapter. Exclusive content for academic educators: A test bank containing 100 questions and a mock risk-adjustment certification exam with 150 questions.

ICD 10 CM Official Guidelines for Coding and Reporting FY 2021 October 1 2020 September 30 2021

ICD 10 CM Official Guidelines for Coding and Reporting   FY 2021  October 1  2020   September 30  2021
Author: Department Of Health And Human Services
Publsiher: Lulu.com
Total Pages: 128
Release: 2020-09-06
Genre: Medical
ISBN: 1716599989

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These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.

Handbook of Obesity Volume 2

Handbook of Obesity   Volume 2
Author: George A. Bray,Claude Bouchard
Publsiher: CRC Press
Total Pages: 658
Release: 2023-12-01
Genre: Medical
ISBN: 9781000960419

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Volume 2 of the 5th Edition of the Handbook of Obesity spotlights on clinical applications for evaluation, diagnosis, prevention, and treatment of obesity. It covers on the several major developments occurred between the previous and the new edition, including the effect of SARS-CoV-2 on people with obesity, the concept of “Precision Medicine”, and new medications approved by USFDA aiding patients with obesity weight loss of 15 to 20%. This volume is structured into 5 parts: Part 1 provides insights from evolution on changes in diet and physical activity, and the implications and results for preventing obesity, health care costs associated with obesity and the cost-effectiveness of obesity prevention and treatment. Part 2 deals with evaluation of overweight patients, approaches for classifying obesity and using this knowledge to evaluate patients, and addressing ethnic and racial considerations in evaluating patients with obesity. Part 3 explains the impact of lifestyle in managing obesity, which include behavioural management, diet, dietary composition, and meal timing, and the effects of physical activity and exercise in weight loss and weight loss maintenance. Part 4 is focused on medications in the management of obesity. This includes drug selection, various classes of drugs, combination of drugs affecting weight loss, effect of herbal agents on weight loss and treatment of obesity in pediatric populations, genetic diseases causing obesity and the role of drugs in treating the dyslipidemias. Part 5 discusses bariatric surgery, its history, procedure and effects in details, and other surgical techniques including electric stimulation of the vagus nerve, gastric balloons, intestinal liners, and liposuction.

Handbook of Obesity Two Volume Set

Handbook of Obesity  Two Volume Set
Author: George A. Bray,Claude Bouchard
Publsiher: CRC Press
Total Pages: 1212
Release: 2024-01-09
Genre: Medical
ISBN: 9781000960600

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This 2 volume set comprises of the 4th edition of Volume 1 and the 5thth edition of Volume 2. The fifth edition of Volume 1 of Handbook of Obesity written by global experts covers the basic science aspects under the broad topic areas of epidemiology, etiology, and pathophysiology of obesity. Divided into 5 sections and detailed in 66 chapters, this edition covers the important advances occurring over the past decades. With a focus on science of obesity and factors participating in the etiology of obesity, this topic is studied from biological, behavioural, and environmental perspectives. Volume 1 is structured into 5 parts: Part 1 focuses on the history, definitions, and prevalence of the obesity. It identifies the historical references to excess weight, obesity in art and literature, direct and surrogate measurements of adiposity and obesity related traits, epidemiology of obesity around the globe, and age, sex, and ethnic variation completes this part of the volume. Part 2 explains the biological determinants of obesity. It explains the bioenergetics, energy dissipation mechanisms and exposure to experimental overfeeding, genetic and epigenetic evidence, metabolic rates, energy expenditure and energy partitioning, and the evidence on infections and adiposity. Part 3 describes the behavioral determinants of obesity. It deals with chapters related to food, beverages, and ingestive behavior, dealing with smoking, breast-feeding, and sleep duration and pattern, and sedentary behavior, occupational work, and leisure-time physical activity and obesity. Part 4 comprises of chapters explaining the environmental, social, and cultural determinants of obesity. The chapters in this section focus on the role of agriculture and the food industry in the current obesity epidemic, social and economic aspects of obesity, and ethnic and cultural differences, and environmental pollutants. Part 5 of this volume discusses the health consequences of obesity. The chapters address important topics such obesity and heart disease, lipoprotein metabolism, insulin resistance and diabetes, metabolic syndrome, cancer, hepatic biology, pulmonary functions, and arthritis and gout, mental health and quality of life, growth and health disorders in pediatric populations, and on bias and discrimination affecting the obese persons. Volume 2 of the 5th Edition of the Handbook of Obesity spotlights on clinical applications for evaluation, diagnosis, prevention, and treatment of obesity. It covers on the several major developments occurred between the previous and the new edition, including the effect of SARS-CoV-2 on people with obesity, the concept of "Precision Medicine", and new medications approved by USFDA aiding patients with obesity weight loss of 15 to 20%. This volume is structured into 5 parts: Part 1 provides insights from evolution on changes in diet and physical activity, and the implications and results for preventing obesity, health care costs associated with obesity and the cost-effectiveness of obesity prevention and treatment. Part 2 deals with evaluation of overweight patients, approaches for classifying obesity and using this knowledge to evaluate patients, and addressing ethnic and racial considerations in evaluating patients with obesity. Part 3 explains the impact of lifestyle in managing obesity, which include behavioural management, diet, dietary composition, and meal timing, and the effects of physical activity and exercise in weight loss and weight loss maintenance. Part 4 is focused on medications in the management of obesity. This includes drug selection, various classes of drugs, combination of drugs affecting weight loss, effect of herbal agents on weight loss and treatment of obesity in pediatric populations, genetic diseases causing obesity and the role of drugs in treating the dyslipidemias. Part 5 discusses bariatric surgery, its history, procedure and effects in details, and other surgical techniques including electric stimulation of the vagus nerve, gastric balloons, intestinal liners, and liposuction.

ICD 10 CM 2021 The Complete Official Codebook with Guidelines

ICD 10 CM 2021  The Complete Official Codebook with Guidelines
Author: American Medical Association
Publsiher: Unknown
Total Pages: 1250
Release: 2020-09-20
Genre: Electronic Book
ISBN: 1640160817

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ICD-10-CM 2021: The Complete Official Codebook provides the entire updated code set for diagnostic coding, organized to make the challenge of accurate coding easier. This codebook is the cornerstone for establishing medical necessity, determining coverage and ensuring appropriate reimbursement. Each of the 21 chapters in the Tabular List of Diseases and Injuries is organized to provide quick and simple navigation to facilitate accurate coding. The book also contains supplementary appendixes including a coding tutorial, pharmacology listings, a list of valid three-character codes and additional information on Z-codes for long-term drug use and Z-codes that can only be used as a principal diagnosis. Official coding guidelines for 2021 are bound into this codebook. FEATURES AND BENEFITS Full list of code changes. Quickly see the complete list of new, revised, and deleted codes affecting the FY 2021 codes, including a conversion table and code changes by specialty. QPP symbol in the tabular section. The symbol identifies diagnosis codes associated with Quality Payment Program (QPP) measures under MACRA. New and updated coding tips. Obtain insight into coding for physician and outpatient settings. New and updated definitions in the tabular listing. Assign codes with confidence based on illustrations and definitions designed to highlight key components of the disease process or injury and provide better understanding of complex diagnostic terms. Intuitive features and format. This edition includes full-color illustrations and visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, codes associated with CMS hierarchical condition categories (HCC), Medicare Code Edits (MCEs), manifestation codes, other specified codes, and unspecified codes. Placeholder X. This icon alerts the coder to an important ICD-10-CM convention--the use of a "placeholder X" for three-, four- and five-character codes requiring a seventh character extension. Coding guideline explanations and examples. Detailed explanations and examples related to application of the ICD-10-CM chapter guidelines are provided at the beginning of each chapter in the tabular section. Muscle/tendon translation table. This table is used to determine muscle/tendon action (flexor, extensor, other), which is a component of codes for acquired conditions and injuries affecting the muscles and tendons Index to Diseases and Injuries. Shaded guides to show indent levels for subentries. Appendices. Supplement your coding knowledge with information on proper coding practices, risk adjustment coding, pharmacology, and Z codes.