RDM: Risk Adjustment Documentation and Coding
Annual face-to-face encounter documenting chronic conditions (HCCs) for risk score capture. Not a HEDIS measure but related to MA quality + payment.
Measure description
Annual face-to-face encounter documenting chronic conditions (HCCs) for risk score capture. Not a HEDIS measure but related to MA quality + payment.
Eligible population
MA risk-adjusted population
Performance drivers
MA capitation; CMS-HCC V28 model.
Documentation & PA strategy
Annual wellness visit (G0438/G0439) capturing all chronic conditions with M.E.A.T. (Monitor, Evaluate, Assess, Treat) documentation.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure RDM measure?
Annual face-to-face encounter documenting chronic conditions (HCCs) for risk score capture. Not a HEDIS measure but related to MA quality + payment.
What drives performance on this measure?
MA capitation; CMS-HCC V28 model.
How should clinicians document for this measure?
Annual wellness visit (G0438/G0439) capturing all chronic conditions with M.E.A.T. (Monitor, Evaluate, Assess, Treat) documentation.
What is the eligible population?
MA risk-adjusted population
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