Ways Risk Adjustment Coders Can Help

Having a documented diagnosis is an essential element when it comes to a patient's care in a risk-adjusted health plan. Such documentation makes it easier for medical practitioners to be as specific as they need to be when making a diagnosis. This is extremely important, as any incomplete or missing documentation can lead to negative outcomes that will affect both the patient, the medical practitioner, and even the medical practice in general. This is where risk adjustment coders come in, as they can help the medical practices improve their RAF score.


Who are risk adjustment coders, and what do they do?

Risk adjustment coders have several responsibilities, including performing medical coding and reviewing medical codes that allow adherence to risk adjustment models. They ensure strict compliance with all the electronic medical records documentation and patient privacy rules. Their responsibilities allow them to bridge the gap in medical documentation and prevent or limit any form of documentation deficiency that could affect the patient and medical practice.


Ways risk adjustment coders can help


Unlike most coding tasks, risk adjustment coders do not focus on submitting codes for services already rendered. Instead, their main goal is to identify all the active and current diagnosis codes in specific details. This makes it possible to calculate each patient's RAF score correctly. The coder ensures that each medical officer's documentation identifies and addresses every form of deficiency through queries to improve the documentation process, which also improves RAF scores. They also ensure that each documentation submitted by a healthcare provider is valid before submitting claims.


Backed by a Certified Risk Adjustment Coder credential, a Risk Adjustment Coder is better equipped to improve a healthcare provider's SAF score by assisting in the following ways:

  • Ensuring that each service date documentation stands by itself

  • Ensuring that the status of chronic conditions, management plans, and clinical indicators are made available in the documentation for support.

  • Confirming that every medical record offers no conflicting content, contains no ambiguity, is complete, detailed, and specific.

  • A Risk Adjustment Coder also uses the Monitoring, Evaluating, Addressing/Assessing, Treatment (MEAT) process to ensure that every documentation supports and falls in line with every applicable risk-adjusted diagnosis for validation.

  • They go through every report, including biopsy, pathology, imaging, consultation, hospital, and lab reports, to identify questions or queries and potential new diagnoses. They also examine all reports to find new risk-adjusted diagnoses.

  • They ensure that all health conditions and chronic diseases or risk-adjustment diagnoses are properly documented at least once every six months.

  • Risk Adjustment Coders also provide healthcare providers with education and training about the documentation process and coding guidelines.


When it comes to patient care in a risk-adjusted health plan, you can never underestimate or exaggerate the importance of consistency in providing complete documentation. That's because it's almost impossible to achieve accurate coding and funding for patient care without such documentation.


Risk adjustment coders help the medical practices improve their RAF score, and our Billing Department is well-equipped to manage that. So, don't hesitate to contact us immediately.


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