Understanding Hierarchical Condition Categories is a good place to start when learning about risk adjustment, particularly from a coding perspective. A Hierarchical Condition Categories (HCCs) list is …

This proprietary tool includes detailed crosswalks and scoring logic for: Elixhauser Comorbidity Index (Mortality & Readmission), CMS-HCC v28, Severity of Illness (SOI) & Risk of Mortality (ROM), …

In risk adjustment coding, documentation describing the diagnoses also establishes the validity of the coding performed. Without it, the diagnosis is not “validated.”

Dec 4, 2025 · What Is Risk Adjustment Coding? Risk adjustment coding is the methodology that assigns ICD-10-CM diagnosis codes to patient encounters to capture health status for value-based payment …

What Is Risk Adjustment Coding? Simply put, Risk Adjustment Coding is a method used to predict healthcare costs by assigning a risk score to each patient based on their health conditions and …

This guide walks you through the basics of risk adjustment coding, explaining how it works and why it’s important. We’ll also share actionable strategies for effective implementation of coding programs.

This book provides conceptual and practical knowledge of risk adjustment to coders, coding managers, medical staff, clinical documentation improvement (CDI) professionals, payers, educators, and students.

Coding accurately using ICD-10-CM: • Appropriate medical record documentation contains pertinent facts, findings, and observations about the patient’s health history, past and present illnesses, ex …

If you have questions, please email the Individual & Family Plan Risk Adjustment Coding Quality and Audit Review team at [email protected].

While all risk adjustment payment models differ in some areas, one common ground they hold is diagnosis coding. Risk adjustment is a payment methodology that uses ICD-10-CM codes, organized …