Coding and Documentation
The federal government reimburses Medicare Advantage plans, like Blue Advantage®, based on the documented health of their members through a method used by CMS called "Risk Adjustment." This reimbursement is based on the anticipated cost of members' healthcare and is what health plans rely on to accurately estimate healthcare costs and provide high-quality affordable Medicare Advantage products.
Providers play an important role in the risk-adjustment process. Medical record documentation and claims coding data are used to help indicate the complete picture of health for plan members. This data also enables Blue Advantage to analyze and design programs to help manage member care.
Documentation and coding must mirror one another in order to accurately capture the patient's complete picture of health. Use our resources below to provide the most accurate, complete coding and documentation possible.
Quality and Risk Coding
- Advanced Illness and Frailty Guide
- Annual Wellness Visit and Routine Physical Exam Guide
- Annual Wellness Visit Tips and Best Practices
- Quality Measures Coding Guide
Risk Coding
Documentation and Coding Tips
Documentation and Coding Guides by Condition:
- Aneurysms
- Atherosclerosis
- Cancer
- Carotid Artery Disease
- Cerebral Infarction, Transient Ischemic Attack (TIA) and Sequela
- Chronic Lower Respiratory Disease
- Congestive Heart Failure
- Deep Vein Thrombosis (DVT)
- Depression
- Diabetes Type 2
- Diabetes Type 1
- Hypertensive Chronic Kidney Disease
- Hypertensive Heart and Chronic Kidney Disease
- Hypertensive Heart Disease
- Weight-Related Diagnoses
Other Documentation and Coding Videos
The following quick videos provide documentation and coding information related to these conditions:
COPD
Heart Failure
Rheumatoid Arthritis
Vascular - Part One
Vascular - Part Two