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.
- Florida Blue Medicare and Commercial Risk Adjustment Best Practices and Coding Educational Guide
- Steps to Success series for Risk Adjustment Documentation and Coding
- Documentation and coding, quality data, and how accurate coding affects your practice:
- Register for training or attend a webinar through the Availity®¹ learning center.
- 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.
Medicare Risk Adjustment
Coding Tips & Best Practices
|Angina Pectoris||December 2023|
|Annual Wellness Visit||May 2023|
|Chronic Kidney Disease||September 2023|
|Chronic Obstructive Pulmonary Disease||November 2023|
|CMS-HCC Model (V28) *new*||April 2023|
|ICD-10 (Best Documentation Practices)||October 2023|
|Lung Cancer||August 2023|
|Sickle Cell Disease||June 2023|
Behavioral, Vascular Health, COPD, Weight, Hypertension, and Chronic Kidney Disease (Testing, Coding, and Documentation Tip Sheet)