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step up your game: how to improve risk adjustment coding accuracy

June 23, 2017

The Office of Inspector General (OIG) sets the bar for coding accuracy at 95 percent, but you can’t achieve that goal without a comprehensive approach that gets it right from the beginning. Are you following best practices to ensure accurate code capture, or is there room for improvement? Here are some concrete steps you can start implementing today to step up your risk adjustment game.

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1. Develop a standard set of coding guidelines based on CMS and your own coding approach.

The Centers for Medicare & Medicaid Services (CMS), the International Classification of Diseases (ICD) book, and the American Hospital Association’s (AHA) Coding Clinic provide a wealth of information related to coding guidelines. However, they can’t account for every diagnosis scenario that a coder comes across in a medical record. To lessen confusion for your coders, agree ahead of time on your philosophy of diagnosis capture across the “gray” areas of coding guidelines, such as your approach to signatures, specific diagnoses, and code capture from a past medical history, condition list, or medication list. Document your coding guidelines, and have them available for reference throughout the coding season.

2. Validate your coders’ understanding of the guidelines before they code any medical record in production.

It’s much easier to maintain coding accuracy if all coders have proven they understand the coding guidelines before they begin a project. And the best way to measure a new coder’s understanding is to assess their accuracy in a test environment before they begin working in a live production environment. Require 100 percent coding accuracy in the test environment, and authenticate each coder’s understanding of the guidelines. Options for validating a coder’s understanding include one-on-one mentoring, 100 percent review of a defined number of coded charts, or collaboration with a QA specialist in a group training session while coding records together.

3. Use data to drive coding decisions, find error trends, and identify areas for targeted training.

Monitoring coding accuracy—whether via a system-generated report or a manually compiled spreadsheet—will enable you to spot error trends such as missed codes or codes that should not have been captured. Leverage data, such as the top ten missed diagnosis codes, to create targeted diagnosis trainings or to set up a secondary audit, which you can provide at the beginning of a project or throughout the season as needed. Recognizing errors, correcting those errors, and communicating across the team will go a long way toward safeguarding your coding accuracy.



These are just a few of the many tips we offer in our new checklist, “8 steps to improving risk adjustment coding accuracy.” Are you ready to raise the bar for your health plan’s coding accuracy? Download the complete checklist, and get started today.

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Amanda Watkins has more than 16 years’ experience in the healthcare industry and six years of expertise in HCC coding. As vice president of coding services, she oversees medical record coding for Verscend’s Medicare, Medicaid, and commercial clients, including retrospective, prospective, RADV, and auditing services. Her responsibilities include overseeing production, quality and operational metrics for Verscend coding staff, and third-party supply partners. Before joining Verscend, Amanda worked as a discrepancy analyst and contract modeler at HCA Healthcare. She is a Certified Professional Coder through the American Academy of Professional Coders.

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