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
|Coding Presentation - Asthma||November 2022|
|Coding Presentation - Autoimmune||October 2021|
|Coding Presentation - Cancer||April 2023|
|Coding Presentation - CHF||October 2021|
|Coding Presentation - COPD||October 2021|
|Coding Presentation - Diabetes||October 2021|
|Coding Presentation - Heart Arrythmia||October 2021|
|Coding Presentation - HIV||October 2021|
|Coding Presentation - Major Depression and Bipolar Disorders||October 2021|
|Coding Presentation - Seizure Disorders||October 2021|
Medicare Risk Adjustment
Coding Reference Materials
|Tip Sheet for Behavioral and Vascular Health, COPD, Weight, Hypertension, and Chronic Kidney Disease||May 2023|
|MRA Coding Newsletter - Annual Wellness Visit||May 2023|
|MRA Coding Newsletter - Dementia||April 2023|
|MRA Coding Newsletter - CMS-HCC Model (V28) *new*||April 2023|
|MRA Coding Newsletter - ICD-10 Coding Best Documentation Practices||December 2022|
|MRA Coding Newsletter - ICD-10 Code Updates||October 2022|
|MRA Coding Newsletter - Diabetes||September 2022|
|MRA Coding Newsletter - Chronic Kidney Disease||July 2022|
|MRA Coding Newsletter - Telehealth||June 2022|
|MRA Coding Newsletter - Peripheral Vascular Disease||May 2022|
|MRA Coding Newsletter - Congestive Heart Failure||April 2022|
|MRA Coding Newsletter - Morbid Obesity||March 2022|
|MRA Coding Newsletter - Social Determinants of Health (SDOH)||February 2022|
|Hierarchical Condition Category (HCC)||October 2021|
|Dementia Documentation and Coding||September 2021|
|Telehealth Documentation||August 2021|
|Cancer and Coding of Neoplasms||July 2021|
|Chronic Obstructive Pulmonary Disease||June 2021|
|Peripheral Vascular Disease||May 2021|
|Congestive Heart Failure||April 2021|
|Chronic Kidney Disease||March 2021|
|Diabetes Mellitus||February 2021|
|Annual Wellness Visit||January 2021|
|Rheumatoid Arthritis||December 2020|
|Cardiac Arrhythmia||November 2020|
|Cancers and Neoplasms||October 2020|
|Chronic Kidney Disease and Chronic Kidney Disease with Other Conditions||September 2020|
|Major Depression, Major Depressive Disorder||August 2020|
|Amputations, Artificial Openings and Transplants||July 2020|
|Diabetes Mellitus||June 2020|
|Documentation Tips for Prevalent Conditions||May 2020|
|Annual Wellness Visit||April 2020|
- Read about coding details and tips in our Florida Blue Medicare and Commercial Risk Adjustment Best Practices and Coding Educational Guide
- View information about the new monthly steps to success series for risk adjustment documentation and coding.
- Register for training or attend a webinar through the Availity®¹ learning center.
- Read about our Commercial Risk Adjustment and/or our Medicare Advantage and Value-Based Risk Adjustment processes including documentation and coding, quality data, and how accurate coding affects your practice
- Send an email to RiskAdjustmentTraining@bcbsfl.com.
1 Availity, LLC is a multi-payer joint venture company. For more information or to register, visit availity.com.