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Risk adjustment, a component of Medicare Advantage and the Affordable Care Act (ACA), helps align payments to health plans with the risk characteristics of people enrolled in each plan.

Accurate risk adjustment relies on comprehensive, face-to-face health assessments of patients. These assessments result in appropriate medical record documentation and diagnosis coding. The diagnosis codes are then submitted to the health plan on a claim and used to determine the level of risk associated with the patient.

Florida Blue has risk adjustment programs in place that align with our commitment to ensuring that quality of care is maintained through the physician-patient relationship. These programs help identify care and coding opportunities that can help prevent and/or detect conditions and encourage members to schedule health screenings, tests and vaccines.

2022

September 2022 MRA Coding Newsletter -- Diabetes
July 2022 MRA Coding Newsletter - Chronic Kidney Disease
June 2022 MRA Coding Newsletter - Telehealth
May 2022 MRA Coding Newsletter - Peripheral Vascular Disease
April 2022 MRA Coding Newsletter - Congestive Heart Failure
March 2022 MRA Coding Newsletter - Morbid Obesity
February 2022 MRA Coding Newsletter - Social Determinants of Health (SDOH)
January 2022 MRA Coding Newsletter - Annual Wellness Visit

2021

December 2021

Coding Newsletter – ICD-10-CM Diagnosis and Guideline Changes for 2022

October 2021 Hierarchical Condition Category (HCC)
September 2021 Dementia Documentation and Coding
August 2021 Telehealth Documentation
July 2021 Cancer and Coding of Neoplasms
June 2021 Chronic Obstructive Pulmonary Disease
May 2021 Peripheral Vascular Disease
April 2021 Congestive Heart Failure
March 2021 Chronic Kidney Disease
February 2021 Diabetes Mellitus
January 2021 Annual Wellness Visit

2020

December 2020 Rheumatoid Arthritis
November 2020 Cardiac Arrhythmia
October 2020 Cancers and Neoplasms
September 2020 Chronic Kidney Disease and Chronic Kidney Disease with Other Conditions
August 2020 Major Depression, Major Depressive Disorder
July 2020 Amputations, Artificial Openings and Transplants
June 2020 Diabetes Mellitus
May 2020 Documentation Tips for Prevalent Conditions
April 2020 Annual Wellness Visit

2019

September 2019 Heart Failure
August 2019 Principles of Documentation and MEAT in the Medical Record
May 2019 Cerebrovascular Accident
April 2019 Medicare Annual Wellness Visit
March 2019 Morbid Obesity, Malnutrition and Cachexia
February 2019 Atherosclerosis of the Aorta and Angina
January 2019 Supplemental Codes Submission 99080

2018

November 2018 Mental Health
September 2018 Sickle Cell Disease
August 2018 Opioid Documentation and Coding
July 2018 Hepatitis
May 2018 Osteoporosis
April 2018 Alcohol Abuse
March 2018 BMI and Obesity
January 2018 Medical Record Chart Procurement in Value-Based Agreements

2017

December 2017 Capturing Prospective Care & Coding Opportunities in 2018
November 2017 Prospective and Retrospective Chart Reviews
October 2017 Cancers and Neoplasms
September 2017 Getting a Handle on Sensitive Codes
August 2017 Human Immunodeficiency Virus (HIV)
July 2017 Chronic Kidney Disease With Other Conditions
June 2017 Chronic Kidney Disease
May 2017 Dropped and Suspect Conditions Cologuard Screening for BlueMedicare Patients
April 2017 Mental Health Coding
March 2017 Importance of Medical Record Requests Commercial Pediatric Risk Adjustment
February 2017 Risk Adjustment Models
January 2017 Documentation Tips for Prevalent Conditions - COPD and Emphysema, Specified Heart Arrhythmia, Diabetes, and Vascular Disease

2016

December 2016 Risk Adjustment 101
November 2016 Amputations, Openings, and Transplants
October 2016 Radiology and Labs
September 2016 BMI Coding
August 2016 Medicare Advantage Annual Wellness Visit
July 2016 Atrial Fibrillation
June 2016 Imaging and Radiology
May 2016 Substance Abuse and Dependence
April 2017 Top Ten Medical Record Documentation and Coding Tips
March 2017 Hepatitis
February 2017 BMI – Adults, Children, and Teens
January 2017 Rheumatoid Arthritis

2015

December 2015 Aortic Atherosclerosis
November 2015 Diabetes
October 2015 Breast Cancer
September 2015 Major Depressive Disorder
August 2015 COPD Annual Diabetic Retinal Exam
July 2015 Healthy Diet and Lifestyle
June 2015 Men's Health Month
May 2015 Rheumatoid Arthritis
April 2015 Diabetes
March 2015 Kidney Disease

 

 

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