Curriculum
From concept to application, you'll learn about the complexities of HCC coding, diagnoses codes and risk codes, the interplay of quality all the way through to revenue.
- Navigate the coding and documentation paradigm shift
- Master the mechanics of hierarchical coding
- Decode the inner-dependencies of HCC coding---diagnoses codes, risk scores and revenue
- Understanding the rules of engagement to evoke evidentiary data needed
- Sharpen your skills with RADV mock audit fire drills
- Distinguish how coding impacts the larger health plan organization from a financial context
- Demystify the fine line between coding and over coding
- Identify the common coding challenges and learn how to become a troubleshooter for your provider offices
Our six-hour online course covers the entire HCC coding landscape
Module 1: Why Do We Have Risk Adjustment? Introduction
- Define the purpose of Risk Adjustment in CMS payments
- Uncover health care program types that use Risk Adjustment for payments
Module 2: Risk Adjustment Overview for the Coder
- Review the CMS HCC timeline of payments
- Understand HCC categories and how to calculate your RAF score
- Learn how six disease interactions increase a RAF score
Module 3: Documentation and Coding for Risk Adjustment
- Understand the difference between coding history v. active conditions
- Recognize the most common guideline changes for 2017/18 ICD-10-CM
Module 4: Medical Record Requirements for Mock Audits
- Recognize the steps and identify criteria required for a mock audit
- Understand how to use mock audit results to reduce future risks
Module 5: Concurrent Workflows to Reduce Risk
- Understand strategic initiatives that can be implemented for improved reporting and provider support
- Review workflow processes in the healthplan and provider office to reduce risks of under-reporting & over-reporting
Module 6: HCC Coding-Coding Impacts
- Review case study examples to determine missed conditions and RADV risks
Audience
- All Levels of Management for Coding & Quality
- CDI Specialists
- HCC Analyts
- HCC Auditor-Educator
- HCC Coding Compliance Specialist
- Data Management Coders
- HCC Coders and Auditors
- Trainers/Educators
- Provider Educators
- Quality Assurance
- Staffing Agencies
- Suppliers
Course Objectives
- Provide a side-by-side comparison of the way risk adjustment tools and program designs work in both the Medicare Advantage and the ACA/HHS marketplace programs
- Explain how the hierarchical models function, and how they roll up coefficients into RAF scores that ultimately affect risk adjusted premiums
- Describe the practical differences in the level of diagnostic coding specificity and chart documentation between FFS and government programs (Medicare Advantage and ACA / HHS marketplace)
- Understand how to access and use official guidance materials on ICD-10 and risk adjustment to grasp and apply the rules, and to perform at a high level of productivity and compliance
- Apply the reasoning to eliminate areas of ambiguity and potential confusion by using allowable elements from past medical histories, other areas of the medical records, as well as queries, to arrive at the optimal codes and documentation.
- Prepare and execute on a contract level RADV audit, whether for Medicare Advantage or ACA / HHS marketplace.
- Understand how to collaborate across functional departments as well as between providers and the healthplan to address end-to-end workflow challenges, including educating providers and problem-solving EMR-based problems
This program has been approved for 6 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.
This program has the prior approval of AAPC for a maximum of 6.0 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. This AAPC approval is valid until 11/30/2024.
$700
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