Why Accurate CMS Coding Is Important
The Centers for Medicare and Medicaid Services (CMS) requires insurance plans submit claims using specific coding for Hierarchical Condition Categories (HCC). These categories represent specific health conditions and diagnoses. Because CMS payments are based on these categories, proper coding is essential for accurate revenue reimbursement.
CMS typically reimburses a plan based on an individual in average health. Risk adjustment allows a Medicare Advantage Plan to compare one member’s health status against this average.
If a plan submits a claim for a chronically ill individual or one with a preexisting condition, it will likely receive higher CMS reimbursement revenues in the future and possibly even retroactive payments for previously undiscovered diagnoses.
EMSI Health works with credentialed coding professionals to review your members’ charts and medical records for coding inaccuracies in order to improve diagnosis capture and promote adherence to CMS guidelines.
Maximize your CMS reimbursement revenue through accurate HCC coding. Find out how EMSI Health can help
Record Review and Coding for the Health Insurance Marketplace
With a tradition of excellence built over more than 40 years, EMSI Health is the leading provider of risk adjustment services, as well as the largest in the industry. Our robust operational framework, experienced staff and proven performance over more than three decades have positioned us to successfully leverage our scalable capacity, provider relationships and technology to deliver complete medical data quickly and efficiently. Our mission to drive improved outcomes for our clients through the delivery of powerful information guides every transaction and interaction conducted, each and every day.
How It Works
EMSI Health is the industry leader in HCC coding and we believe that coding quality and accuracy is as important as you do. Once member diagnoses from medical records and Healthy House Calls are entered into our coding database, they are mapped to the optimal HCC category. In addition to providing an electronic file of directives that are typically integrated into the health plan’s care management program, we also provide risk-adjusted data for Edge Server delivery.
Learn more about what we can do to help you prepare for and succeed in the Health Insurance Marketplace.