Foster Compliance With These 4 Risk Adjustment Steps

Why This Topic Matters

Risk adjustment depends on documentation integrity and source validity, so understanding these requirements can help practices reduce compliance risk and improve coding readiness. The article is relevant for organizations building or refining documentation review processes for outpatient and patient-encounter-based reporting.

Article Sections

1. Step 1: Documentation requirements

   Introduces core documentation elements tied to CMS expectations for risk adjustment review and reporting. Focuses on what must be present in the record at a high level.

2. Step 2: Active conditions and acceptable provider types

   Discusses capturing active medical conditions from qualifying encounter documentation and provider sources. Also distinguishes between acceptable and unacceptable provider categories in general terms.

3. Step 3: Impermissible document sources

   Outlines categories of documents that should not be used as supporting sources for risk adjustment purposes. Includes broad examples of source types and encounter types to avoid.

4. Step 4: ICD-10-CM updates and guidelines

   Emphasizes the need to stay current with code set changes and guideline updates. Provides a general reminder about maintenance and review activities.