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Coding Corner

The federal government reimburses Medicare Advantage plans 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.

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