Best Practices for Medicare Advantage Plans and Risk Adjustment Documentation

The Risk Adjustment Solution is a systematic approach used by the C.M.S. to quickly and precisely reimburse Medicare Advantage Organizations (M.A.O.s) for their participants' predicted future healthcare costs by adjusting billing based on population data and the participants' overall health.

Medicare Advantage Plans, commonly known as Part C, are provided by Medicare-approved private entities that must adhere to Medicare's rules and regulations. The majority of Medicare Advantage Plans provide drug coverage (Part D).

 

Utilizing CMS-HCC Risk Adjustment Solution, M.A.O. coverage is better for participants with a relatively high condition prevalence and less for better and healthier participants to match with forecasted cost of healthcare more accurately.

 

What is the operation of Medicare Advantage Plans?

 

When individuals enroll in a Medicare Advantage Plan, Medicare reimburses a predetermined sum to the organization that offers the insurance cover every month. Healthcare organizations that provide Medicare Advantage Plans must abide by Medicare's regulatory requirements. 

 

However, any Medicare Advantage Plan can start charging varying excessive expenses and have various regulations about obtaining services. These guidelines are prone to revision each year. Any amendments to the plan must be communicated to the user before the beginning of the following registration year.

 

If a user enrolls in a Medicare Advantage Plan, the user will still have the same protections and benefits as if s/he was on basic Medicare.

 

Best Practices for Data and Information Documentation

 

Provider reporting must be precise and unambiguous to ensure that correct and detailed diagnostic information is captured. Coders can only designate a diagnostic code based on what is reported in the patient's chart.

 

When reporting, healthcare providers should take note of the following:

 

· On every patient record sheet, the date of care delivery, the patient's name, health record number, and the provider's name should be included.

· Every medical condition discussed during the visit should be accompanied by a statement emphasizing the impact on care delivery, intervention, and monitoring.

·  Ascertain that a diagnosis is noted and referenced in the health record for each drug prescribed, along with the condition for which the drug is being recommended.

· At least once a year, document chronic diseases that need continuing care and monitoring.

    

Best Practices in H.C.C. Coding

·  Recruit an H.C.C. Coding Specialist in the team.

·  Train through an ongoing H.C.C. coding training plan.

·  To submit reports faster, use the actual reporting attributes of value-based programs.

·   Prepare a detailed profile of every patient by incorporating the specificity of H.C.C. chronic illnesses.

·   Make use of the M.E.A.T.