195.034 Risk Adjustment under PPACA


Risk Adjustment under PPACA: Because the risk adjustment relies heavily on diagnostic information, the Texas Medical Association will (1) develop educational materials to inform physicians of the implementation and impact of risk adjustment under the Affordable Care Act focusing on coding to the highest degree of specificity, documenting the patient's diagnosis both in the medical record and on the claim sent to the health plan, as well as, eliminating the use of NOS (not otherwise specified) codes and (2) work closely with EMR vendors, practice management system vendors, clearinghouses, and health plans to determine how each will receive, transmit, and process this information (CSE Rep. 4-A-12).

Last Updated On

October 07, 2016