Hcc rxhcc coding - Study guides, Class notes & Summaries

HCC Coding-Risk Adjustment Test Questions with Answers What two models are used to calculate a RAF score properly? What do these models allow to happen to the final risk score? - Answer-Additive and Hierarchical. Allows for more than one disease to impact the final risk score. What is diagnostic hierarchies? - Answer-Prevents multiple diagnoses in the same disease group from skewing the risk score with a higher score. The more severe diagnoses "trumps" the lower diagnoses within the s...

HCC-RxHCC Coding Updates & Documentation Standards Questions and Answers Diagnosis Limit - Answer-Maximum of 12 diagnoses per encounter Best Judgement - Answer-Using discretion to select additional diagnoses Toxic Metabolic Encephalopathy - Answer-Brain dysfunction due to toxic substances Septic Shock - Answer-Life-threatening organ dysfunction from infection Bilateral Pleural Effusions - Answer-Fluid buildup in the lungs on both sides Moderate Mitral Stenosis - Answer-Narrowi...

Which of the following elements would be taken into consideration for risk adjustment? 1) Gender 2) Place of service 3) Provider type 4) Socioeconomic status 5) Insurance status (Medicare, Medicaid, duel-eligible) 6) special patient specific conditions for example involvement in hospice or being an end stage renal disease ESRD patient. Which coding guidelines are followed in risk adjustment coding? ICD-10-CM coding guidelines What is the acronym use for risk adjustment codin...

ADLs patient functional abilities Activities of Daily Living Diagnosis-Based Risk Adjustment Examples HHS HCC- Commercial, Individual, and Small Group CDPS Medicare HCC-C DRG-Inpatient ACG- Outpatient HHS HCC Health Human Services Hierarchical Condition Category CDPS Medicaid Chronic Illness and Disability Payment Systems HCC-C Medicare Hierarchical Condition Category Part C DRG Diagnosis Related Groups (inpatient) ACG Adjusted Clinical Groups...

aapc crc exam 9 Top Questions and answers, 100% Accurate, rated A+ purpose of risk adjustment - -allows CMS to pay plans for the risk of the beneficiaries they enroll, instead of an average amount for Medicare beneficiaries adjusting payment plans - -CMS able to make appropriate and accurate payments for enrollees with differences in expected costs risk scores - -measure individual beneficiaries' relative risk and are used to adjust payments for each beneficiary's expected expenditu...

HCC/RxHCC Coding Updates & Documentation Standards RxHCC - answerMedicare's RxHCC model for outpatient pharmacy costs HCC - answerHierarchical condition categories for medical care MEAT - answerMonitoring, Evaluation, Assessment, Treatment criteria for diagnoses Top 10 RxHCC - answerPopular RxHCCs include Hypertension, GERD, Hyperlipidemia ICD 10-CM Guidelines - answerCode all current conditions affecting patient care With - answerInterpreted as 'associated with' in coding guidelines ...