Medical Risk Adjustment

Health care providers are undergoing a massive shift in how health care is delivered—and how it’s paid for. It’s a move from fee-for-service, or volume care—where the more you do, the more you get paid—to value-based care—where physicians are rewarded for providing high-quality, efficient care. Many factors drive success in value-based care, but one of the most crucial is Medical Risk Adjustment. 

Medical Risk Adjustment (MRA) Education Module

MRA helps health insurance payers – including Medicare – understand how sick your patients really are, as indicated by their risk scores.  MRA is used in value-based models to ensure that cost targets are adjusted to align with the illness burden of the population. The NHN has created a quick 15 minute video to help you understand how MRA works and what you can do to insure you are not penalized for taking care of sicker patients.

Medical Risk Adjustment Education Module

The Basics of Medical Risk Adjustment

The NHN has a developed a quick, one-page document to help you or your fellow providers and coders understand WHAT MRA is, WHY it is important, HOW to optimize risk capture, and a quick example on how MRA WORKS.

Medical Risk Adjustment One-Page Explainer

Hierarchical Condition Category (HCC) Coder Reference Guide

This resource guide is based on the HCCs most frequently used within Nebraska Health Network. Please note that the resource guide is not intended to be a comprehensive list of all HCCs/ICD-10s.

HCC Coder Reference Guide
Interactive PDF

Proper Documentation Supports Coding Accuracy

M-E-A-T is a common acronym used by coders to identify documentation that supports coding accuracy:

  • Monitor
  • Evaluate
  • Assess or Address
  • Treat

Incorporating one or more of the M-E-A-T details at a face-to-face visit for each condition that requires or impacts patient care treatment or management will put you on the path to success in capturing risk. Download this one-page overview for more information.

 

Medical Risk Adjustment M-E-A-T

 

Hierarchical Condition Category (HCC) Coding

The NHN Medical Risk Adjustment Provider Quick Reference Guide provides an overview of Hierarchical Condition Category codes and is available in both one-page and pocket guide formats. Please note that the resource guide is not intended to be a comprehensive list of all HCCs/ICD-10s.

HCC Quick Reference Guide
One Page Format

HCC Quick Reference Guide
Pocket Guide

Provider Quick Reference Pocket Guide