Risk Adjustment/Coding Toolkit
NOTE: You must login to your Alliance account to access the articles and resources below. Some content may only be accessible to Alliance members.
Featured Toolkits
Vendor Accountability Initiative | 2022 Poster Project | COVID-19 | DE&I | FWA Case Sharing | Healthcare Policy | Interoperability | Leadership Org Charts | Maternal Health | Medicare Advantage | Member Experience | No Surprises Act | Pharmacy | Policy and Procedures | Risk Adjustment/Coding | SDoH | Star Ratings
Risk Adjustment Department Best Practices
Risk Adjustment Best Practices Summary document for Health New England. Contains information around Policies, Procedures, Tools and Roles in the Health New England Risk Adjustment department.
Risk Adjustment Organizational Chart
Organizational Chart showing the location of the Risk Adjustment department at Health New England.
CMS CY 2018 Advance Notice
Advance Notice of Methodological Changes for Calendar Year (CY) 2018 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2018 Call Letter
Aspire coding workgroup case studies Feb 2017
This call is one in a series designed for the Alliance coding work group. These calls showcase one health plan at a time, whose team is responsible for sharing multiple coding case studies with the other group members for discussion.
Risk Adjustment Best Practices Worksheet
This template and worksheet is designed to assist Health Plan Alliance member organizations in sharing risk adjustment department best practices. Information gained through this exercise will be presented at the 2017 Feb Risk Adjustment Value Visit and shared in the member library.
Recording: Alliance coding work group - SelectHealth case studies
This call is one in a series designed for the Alliance coding work group. These calls showcase one health plan at a time, whose team is responsible for sharing multiple coding case studies with the other group members for discussion.
SelectHealth Coding Workgroup case studies Jan 18, 2017
This collection of case studies from SelectHealth are for the Jan 18 2017 Alliance coding workgroup session.
Gundersen coding work group case studies Nov2016
This collection of case studies from Gundersen Health plan is for the Nov 2016 coding work group webinar and discussion
ICD-10-CM Official Guidelines for Coding and Reporting - FY 2017
The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government?s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a companion document to the official version of the ICD-10-CM as published on the NCHS website. The ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings. The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO)
Recording: Alliance coding work group: Paramount case studies
This collection of case studies is used as a training tool and resource for the Alliance coding work group and is referenced by coders attending our webcast workshop in Sept 2016. Participants in the live call earn CEUs from AAPC and AHIMA.
Coding work group case study collection from Paramount Sept 2016
This collection of case studies is used as a training tool and resource for the Alliance coding work group and is referenced by coders attending our webcast workshop in Sept 2016. Participants in the live call earn CEUs from AAPC and AHIMA.
Recording: Coding work group Health Alliance Medical Plans
Health Alliance Medical Plan has compiled multiple case studies for discussion during the July 2016 coding work group session
Health Alliance Medical Plan Coding Work group materials July 2016
Health Alliance Medical Plan has compiled multiple case studies for discussion during the July 2016 coding work group session
Coding Reviewer
Perform onsite or electronic audits of medical records/claims to ensure proper medical diagnoses are being submitted for reimbursement. Responsible for the validation of existing diagnosis codes as well as the identification of missing diagnosis codes not submitted on the claim.
Recording: Coding work group case study collection form SelectHealth June 2016
SelectHealth case study for the coding work group
Feedback Tool SOP_Health New England
This document outlines our standard operating procedure for our Chart Review Feedback tool. Also included are examples of the template Engagement letter that is sent to practices at the beginning of the review, Exit letter informing them that the review is complete, and examples of the tools attached to the Feedback summary that provides them with information around our findings.
Coding work group case study collection form SelectHealth June 2016
This collection from SelectHealth is the coding work group case study pre-work from the June 2016 work group meeting.
recap: Coding work group April 28
The Health New England team compiled take aways from our April 28 webinar for the Alliance Coding Work Group