ICD-10-CM is the standard transaction code set for diagnostic purposes under HIPAA. It is used to track health care statistics/disease burden, quality outcomes, mortality statistics and billing. The proper use of ICD-10-CM codes will result in fewer claim denials, less time with payers trying to justify increased clinical resources for the patient and a higher revenue stream. Therefore, it is vital to educate yourself and your staff on appropriate coding, which should result in appropriate payment.
- Tracking public health conditions (complications, anatomical location)
- Improving data for epidemiological research (severity of illness, comorbidities)
- Measuring outcomes and care provided to patients
- Making clinical decisions
- Identifying fraud and abuse
- Designing payment systems/processing claims
Risk adjustment is a modern payment model that uses both demographics and diagnoses to determine a risk score which predicts how costly the individual's care will be for the coming year. Risk adjustment models improve reimbursement and provide a better picture of patient populations.
- Medicare Retrospective Chart Reviews performed by clinical coding team
- Electronic Patient Assessment Solution Suite (ePASS) through Inovalon for selected Medicare members
- ePASS member eligibility information on Medicare roster panel on portal
- Inovalon In-Home Assessments (IHAs) for both Medicare and Medicaid members
- Stellar Health’s web-based recapturing incentive program for both Medicare and Medicaid members if provider is eligible
- Provider Education
- One-on-One trainings
- Provider Reports
- Webinars on coding, documentation and risk adjustment
Our ICD-10 Coding Guide is intended to reduce the amount of time office personnel spend determining ICD-10 coding information and ensure your claims are processed in an accurate and timely manner.