Chapter 7 - Risk Adjustment - Medicare Claims Processing Manual

In the Current Procedural Terminology (CPT) manual, Appendix G, it covers Medicare "Internet-Only Manuals" (IOMs).

If you search in a web browser for IOM, you may find the Centers for Medicare & Medicaid Services (CMS) website where there is a section entitled "Medicare Managed Care Manual". This is an excellent reference that covers many aspects of the risk adjustment process.

I have listed the links below:

Internet Only Manuals: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs

Internet Only Manual, Publication #100-16 entitled Medicare Managed Care Manual:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912

Internet Only Manual, Chapter 7 - Risk Adjustment, Medicare Managed Care Manual:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c07.pdf

Once you reach this .pdf you may find this to be a great reference and save to your computer for future reference.

Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

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