Curriculum

  • Overview of RA impact across business functions
  • Understand the logic, background, thought process behind RADV & Auditing
  • Learn best practices to ensure compliance and mitigate risk with complete and accurate documentation
  • Calculate your ultimate raw RAF score
  • Map diagnoses to HCC codes; demystifying the Trumping Effect
  • Learn RA strategies to maximize your CMS bid
  • Connect revenue connection between quality and value based payments

This comprehensive 3-hour online course includes highlights from our 8-hour live workshop content  and additional topics

Module 1: Why Do We Have Risk Adjustment? Introduction and History

  • Appreciate the Evolution of Healthcare Acts that have led to Medicare Advantage
  • Identify Program Implementations that changed RA Requirements, Payments and Enrollment Trends

Module 2: What is Risk Adjustment? Core Concepts

  • Realize the purpose of Risk Adjustment in CMS payments
  • Review key components of Medicare Advantage and HHS Risk Adjustment models

Module 3: The "How" of HCCs: From diagnosis to HCC and Back Again

  • Understand hierarchical structure and diagnostic codes for HCC coding
  • Review risk coding v. fee-for-service for reimbursement purposes

Module 4: Now Do The Math: Calculating a Risk Score

  • Calculate the normalization factor and it's impact on risk scores
  • Appreciate using codes accurately for reimbursement

Module 5: The Medicare Two-Model Solution: One Is Not Enough

  • Compare Part C and Part D Risk Adjustment models

Module 6: Plugging Risk Adjustment Into The Annual CMS Bid

  • Understand the steps and roles for bid completion
  • Identify how and when Risk Adjustment influences the bid process

Module 7: The Nuts and Bolts for Revenue Management and Healthplan Compliance

  • Identify RAPS data submission and flow of Risk Adjustment data compared to EDPS data submission flows
  • Identify where to find CMS information regarding the requirements of RAPS

Module 8: The Acid Test: The CMS Risk Adjustment Data Validation Program

  • Review the methodology used by CMS for the RADV including population selection factors, sampling factors, and payment error calculations

Module 9: Applying The Tools: Program Management and Operations

  • Learn how to capture HCC diagnoses annually through prospective and retrospective assessment actions
  • Close gaps and create optimal results with care management, quality and provider engagement

Module 10: Risk Adjustment by Lines of Business

  • Define the differences in Risk Adjustment models: CMS, HHS and Medicaid

Module 11: The Three HHS Models: One Is Not Enough Again

  • Understand the three HHS models and how each is used

Module 12: Win, Lose or Draw: The Zero-Sum Game of HHS Risk Adjustment

  • Learn how the HHS marketplace determines healthplan level liabilities
  • Discover how risk adjustment strategies are critical to financial survival in the HHS marketplace

Module 13: Going Big: Extrapolation in Risk Adjustment Programs

  • Compare extrapolation v. non-extrapolation methods used during an audit

 

$595 Enroll Now