A user friendly, interactive version of Accuracy in Documentation and Coding, our most requested provider risk adjustment (RA) tool. Includes 2008, 2009 and 2010 HCC factors.

This tool allows you to calculate a member’s actual risk score. Includes 2008, 2009 and 2010 payment year factors.

These fact sheets provide important documentation information for physicians and other clinicians about commonly mis-coded conditions in an office setting. All of them are brief, and designed to help clinicians—most can be printed on a half sheet of printer paper! We hope you’ll use them to educate your clinicians about appropriate documentation in an office setting. Choose from:

CMS has updated the list of acceptable physician specialties for risk adjustment. This list, released April 18, 2011, has an effective date of January 1, 2010.

This file contains the CMS-HCC diagnosis code groupings, with documentation and coding information for problematic diagnosis codes.

This file contains the diagnosis mappings for the CMS-HCC, ESRD/PACE-HCC and RxHCC models for the 2012 payment year (2011 service year).

This paper provides up-to-date basic facts about the importance of EMRs and their practical utility for busy clinicians and professionals. If you do not have time to read a whole book on this topic, download this file now.

ICD-9-CM Codes, CMS-HCC and RxHCC models.

A pocket sized ICD-9 tool for PCPs and hospitalists. Just print on card stock front and back, fold in thirds and it’s ready to use.

This analysis of the Medicare Advantage 2009 Rate Announcement describes changes to CMS payment for 2009, an explanation of the proposed coding intensity adjustment, and CMS risk adjustment data validation (RADV) plans for 2008 and beyond.

A supplement to the Summary of the CY2009 Rate Announcement, this tool compares payment year 2008 and 2009 HCC and demographic factors.

The Superbill Generator allows you to select ICD-9 codes based on specialty or body system, and create a diagnosis code based superbill.

Downloadable version of the 2007 (DOS) risk score calculator. The 2008/2009 version is available online here.

A one page handout that explains the appropriate documentation and coding of diabetes and Chronic Kidney Disease.

Looking for information on Signature logs? In the attached file, we’ve provided a number of resources for you on physician signature requirements. Although CMS will not accept a signature log for a Risk Adjustment Data Validation (RADV) for MA members, they are still acceptable in Fee-For-Service (FFS) Medicare.

If you would like to use a signature log for FFS Medicare and other insurers who accept them, we have provided a signature log for your use. Remember that the signature you use on the log must be your normal signature, so that a match between the log and a medical record is possible.

In the file you will find:

• A brief presentation on Medicare signature requirements
• A sample signature log
• A Medicare Medlearn Article on physician signature requirements. NOTE: These requirements do not apply to Medicare Advantage

This tool shows the CMS timeline for submission of risk adjustment data through dates of service 12/31/13.

Confused about lag, non-lag and final payment types in the Risk Adjustment Submission Timetable? This document explains what these terms mean.

This is the official Health Plan training manual for Part C. Contents include everything from the history of Risk Adjustment, Data Submission, and Medical Record Review.

On September 15, 2010, the ICD-9-CM Coordination and Maintenance Committee finalized a decision to implement a partial freeze for both ICD-9-CM codes and ICD-10-CM and ICD-10-PCS codes before the ICD-10 implementation date of October 1, 2013. This CMS document explains what’s known to date.

This is the final full update of ICD-9 codes prior to the implementation of ICD-10 on October 1, 2013. The codes in this file are effective 10-1-2011. The ICD-9 update on 10-1-2012 will only reflect new diseases and/or technologies. There are 168 new ICD-9 diagnosis codes, 41 diagnosis codes with title (description) changes, and 33 invalid codes. There are no deleted codes for 2012. There are three tabs in the file.

We do not expect to have an update to the CMS-HCC Model until sometime after October 1, 2011. Any revisions to the CMS-HCC Model will be effective 1-1-2012.

Full text of the ICD-9 codes, by year.

NEW: Full text of the 2012 ICD-9.

CMS answers to past questions related to Risk Adjustment Data Validation Studies.

This checklist was used in the last National RADV to assist health plans in selecting the "One Best Medical Record" for submission. For more information on the RADV process, please review the RAPS Participant Guide on this page.

CMS Pilot RADV Findings—for services rendered July 1, 2001 through June 30, 2002, Published July 27, 2004.