Reexamining standards for better risk adjustment coding

Risk adjustment continues to be a highly scrutinized area of healthcare coding, increasingly so as Medicare Advantage enrollment grows and oversight intensifies. To meet the demands of the moment, healthcare organizations are under increasing pressure to ensure that hierarchical condition category (HCC) diagnoses used for risk adjustment payment are both accurate and defensible. However, many still operate under the assumption that risk adjustment coding follows a different set of rules than traditional diagnosis coding. For better results, health systems should adjust their perceptions of coding and realize that the coding practices that drive outpatient care are central to both outpatient care and risk adjustment reporting.

Risk adjustment continues to be a highly scrutinized area of healthcare coding, increasingly so as Medicare Advantage enrollment grows and oversight intensifies. To meet the demands of the moment, healthcare organizations are under increasing pressure to ensure that hierarchical condition category (HCC) diagnoses used for risk adjustment payment are both accurate and defensible.

However, many still operate under the assumption that risk adjustment coding follows a different set of rules than traditional diagnosis coding. For better results, health systems should adjust their perceptions of coding and realize that the coding practices that drive outpatient care are central to both outpatient care and risk adjustment reporting.