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    ICD-10

Risk Adjustment Process

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.

RPM Revenue Program Management

 

For More Information

If you have questions or want to learn more about risk adjustment refer to the following:

 

Read our monthly QRPM newsletters.
Release Date Topics
February 2021 Diabetes Mellitus
January 2021 Annual Wellness Visit
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

Archived QRPM Newsletters

  • 2019
    Release Date Topics
    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
      Release Date Topics
      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
        Release Date Topics
        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
          Release Date Topics
          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 2016 Top Ten Medical Record Documentation and Coding Tips
          March 2016 Hepatitis
          February 2016 BMI – Adults, Children, and Teens
          January 2016 Rheumatoid Arthritis
          • 2015
            Release Date Topics
            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
            • Read about coding details and tips in our Florida Blue Medicare and Commercial Risk Adjustment Best Practices and Coding Educational Guide 2020.
            • Read about online documentation and coding training that earns you continuing education credits.
            • Read about important changes regarding Comprehensive Quality & Risk Program On Hold Effective Jan. 1, 2018
            • Read about our risk adjustment process, including documentation and coding, quality data and how accurate coding affects your practice.
            • Complete training or attend a webinar through the Availity®¹ learning center.
            • Read FAQs on the Comprehensive Quality & Risk Program.
            • 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.

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