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.
For More Information
If you have questions or want to learn more about risk adjustment refer to the following:
Read our monthly QRPM newsletters.
|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|
|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|
- 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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