Amerigroup Community Care is committed to helping providers offer quality care and services to the members in our network. The resources on this page provide guidance and instructions to help providers serve members with Medicare Advantage plans.
Providers play a key role in risk adjustment activities for Medicare Advantage plans. The goal of Medicare risk adjustment is two-fold: (i) to accurately and comprehensively document diagnosis information to ensure appropriate member care and management; and (ii) to submit accurate and complete diagnosis data to the Medicare Advantage plan to help ensure appropriate payment to both the plan and providers. Annually, each member’s health status is determined by the member’s demographics along with the conditions assessed, diagnosed, and documented in the member’s medical record. Review this document to learn more about the provider’s role in risk adjustment.
ICD-10-CM requires medical record documentation to be more specific to ensure the most accurate code is assigned. To assist with accurate diagnosis coding and billing compliance for Medicare Risk Adjustment, included are the top ten ICD-10-CM documentation and coding tips.
The ICD-10-CM Coding Reference Guide contains some of the more commonly reported conditions in Risk Adjustment for Medicare Advantage. The tables within the reference guide are broken down by condition type, they include certain diagnosis (ICD-10-CM) codes and code categories along with their descriptions. Additionally, some helpful coding tips are included.
This one-page document provides medical record documentation tips for risk adjustment purposes for Medicare Advantage. Reference these tips for documenting to the highest degree of specificity to ensure the most appropriate ICD-10-CM code is assigned.
These publications contain a summary of the diagnosis codes that map to the CMS-HCC Risk Adjustment Model(s). This publication includes the ICD-10-CM codes, HCC codes and category descriptions, along with the disease hierarchies.
A useful and concise one-page publication focusing on a specific condition(s) with details regarding the clinical definition, diagnostic criteria, and relevant ICD-10-CM coding guidance with impact to CMS-HCC code(s) assignment.
These four-page coding brochures were created to assist providers through ICD-10-CM coding by giving a detailed background, specific diagnosis coding guidance, educational elements, and references for specific condition(s).
This Annual Wellness Visit (AWV) Fact Sheet provides details on what an AWV visit is, who can perform the AWV, who is eligible for the AWV, and more. The table of acceptable physician specialty types for risk adjustment data submission is also included.
This publication contains an overview of the ICD-10-CM coding guidelines in which a causal relationship can be assumed between certain conditions.