June 2020
Coding Education Available for Medicare Advantage HMO Providers
Blue Cross and Blue Shield of Illinois (BCBSIL) has a team of Coding Compliance Specialists who offer coding and documentation education to assist providers in accurately capturing and documenting patient conditions. The Coding Compliance Specialists are available to help contracted Medicare Advantage HMO providers with education on coding practices and to assist providers with questions about industry coding standards. The education may be especially helpful to physicians, coders, administrators, office and billing staff.
Why This is Important
Capturing patient diagnoses in the medical record assists providers and health plans in increasing health outcomes and coordinating care. In addition, the Centers for Medicare & Medicaid Services (CMS) risk adjustment program requires that all chronic conditions submitted through claims data have appropriate medical documentation. The Coding Compliance Specialists documentation and coding reviews help clinicians provide the necessary support in the medical record.
WHAT WE OFFER
Coding Documentation and Education
- CMS Medicare Advantage (MA) documentation requirements (risk adjustment overview)
- Diagnosis-specific, coding education
Coding Support
- Chart reviews based on data analytics and coding and documentation trends
- Annual health assessments
- Coding accuracy
- CMS and industry documentation guidelines
Data
- Supplemental reporting to assist with risk adjustment efforts and improving accuracy of patient Hierarchical — Condition Category (HCC) scores
Providers May Achieve:
- Coding accuracy
- Documented Monitoring, Evaluating, Assessing/Addressing and Treating (MEAT)
- Highest level of specificity
- Supporting documentation for all conditions and diagnoses documented
- All active conditions documented and submitted on the claim
If you’re interested in working with the Coding Compliance Specialists team, have your Medicare Advantage HMO Medical Group/Independent Practice Association (MG/IPA) administrator contact their Provider Network Consultant (PNC).
The material presented here is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly.