Coding and Documentation Takes Center Stage

RISE members are hungry for insights and guidance about coding in this world of risk adjusted health insurance.  In particular, the coders are asking for opportunities to learn from those who have a grasp on deciperhing the complex and specific interpretations of ICD coding.  At the abstract level, it is rather simply and straight-forward.  But in the specific situations of real world charting, not so much. There are weighty concerns about legal and compliance implications, as well.  That is what makes the cheese binding, as my father used to say.  The charts are the unalterable source of truth, which is not in dispute.  But how do you put all the pieces of the chart together to support a diagnosis?  And how would a CMS auditor come down on your decision in a RADV audit?  

RISE is very interested in making sure we all do the right thing.  We want to be sure that everyone is highly compliant.  We also want to ensure that the risk adjustments that are derived from the diagnoses accurately compensate the MAO for the prospective healthcare risks.  

The first step is a workshop that we are putting on in Coral Gables on November 17th, which should provide a lot of input into the discussion about what the right thing looks like in practice.  

I hope to see you there, but if you cannot join us, please join the conversation.  We want to hear from you.  What are the toughest situations you run into?  Where are the key points of deciding how to decide what code to capture and report?  Are there "bright lines" you recommend?  

Make your voice heard! Send me your thoughts and suggestions:

Kevin Mowll



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