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Risk Adjustment Program

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.

Commercial Risk Adjustment

Coding Reference Materials

Medicare Risk Adjustment

Coding Reference Materials

File Name Type Updated
Tip Sheet for Behavioral and Vascular Health, COPD, Weight, Hypertension, and Chronic Kidney Disease PDF May 2023
MRA Coding Newsletter - Annual Wellness Visit PDF May 2023
MRA Coding Newsletter - Dementia PDF April 2023
MRA Coding Newsletter - CMS-HCC Model (V28) *new* PDF April 2023
MRA Coding Newsletter - ICD-10 Coding Best Documentation Practices PDF December 2022
MRA Coding Newsletter - ICD-10 Code Updates PDF October 2022
MRA Coding Newsletter - Diabetes PDF September 2022
MRA Coding Newsletter - Chronic Kidney Disease PDF July 2022
MRA Coding Newsletter - Telehealth PDF June 2022
MRA Coding Newsletter - Peripheral Vascular Disease PDF May 2022
MRA Coding Newsletter - Congestive Heart Failure PDF April 2022
MRA Coding Newsletter - Morbid Obesity PDF March 2022
MRA Coding Newsletter - Social Determinants of Health (SDOH) PDF February 2022


File Name Type Updated

ICD-10-CM Diagnosis and Guideline Changes for 2022

PDF December 2021
Hierarchical Condition Category (HCC) PDF October 2021
Dementia Documentation and Coding PDF September 2021
Telehealth Documentation PDF August 2021
Cancer and Coding of Neoplasms PDF July 2021
Chronic Obstructive Pulmonary Disease PDF June 2021
Peripheral Vascular Disease PDF May 2021
Congestive Heart Failure PDF April 2021
Chronic Kidney Disease PDF March 2021
Diabetes Mellitus PDF February 2021
Annual Wellness Visit PDF January 2021
Rheumatoid Arthritis PDF December 2020
Cardiac Arrhythmia PDF November 2020
Cancers and Neoplasms PDF October 2020
Chronic Kidney Disease and Chronic Kidney Disease with Other Conditions PDF September 2020
Major Depression, Major Depressive Disorder PDF August 2020
Amputations, Artificial Openings and Transplants PDF July 2020
Diabetes Mellitus PDF June 2020
Documentation Tips for Prevalent Conditions PDF May 2020
Annual Wellness Visit PDF April 2020




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