FHIMA | Introduction to Risk Adjustment Documentation & HCC Payment Models

Introduction to Risk Adjustment Documentation & HCC Payment Models brings together hard-to-find information about risk adjustment (RA) coding and hierarchical condition categories (HCCs) in a new comprehensive resource that explains this complex reimbursement methodology.

Overview:

Introduction to Risk Adjustment Documentation & HCC Payment Models brings together hard-to-find information about risk adjustment (RA) coding and hierarchical condition categories (HCCs) in a new comprehensive resource that explains this complex reimbursement methodology. Now your organization will have a guide that provides both the “big picture” and the fine detail needed to document, code, and report essential information so that accurate risk levels are assigned and appropriate reimbursement received.

Originally developed by CMS as a risk-adjusted payment method for Medicare Advantage (MA) plans. HCCs are now used in a variety of value-based reimbursement (VBR) programs. Our new guide helps you navigate the shift from a fee-for-service environment to VBR and provides the tools necessary to ensure risk levels and resources are aligned.

Objectives:

  • Understand risk adjustment coding and HCCs. Three types of HCCs covered under Medicare, CMS-HCC, Rx-HCC, and ESRD/PACE-HCC are explained. HSS-HCCs used for commercial plans.
  • Learn which demographic factors and conditions impact risk. Discover the role chronic conditions play in overall risk adjustment, how the risk adjustment factor (RAF) score is calculated, and how the cumulative RAF score for covered beneficiaries drives payments to health plans.
  • Understand the provider’s role. Documentation and coding are the basis for delineating health status and calculating risk. Use the clinical documentation improvement strategies to increase coding specificity and translate into accurate RAF scores.
  • How RAF scores are calculated. Using case studies to identify conditions that impact health status and cost of care. Calculate RAF scores for patients to quantify risk.

We will cover the following:

  • History and purpose of RAF
  • Key terms definitions
  • Acceptable provider types
  • Payment methodology and timeline
  • Coding and documentation
  • Tools for risk adjustment
  • Coding scenarios
  • Guidance for developing internal risk adjustment coding policies
  • Audits
  • Risk adjustment tables

Suggested Audience

C-suite professionals, CDI specialists, profee billers, RHC managers, HIM managers, and managed care contracting.

Questions

For more information, please contact Barbara Flynn at 407-841.6230.

Published:

January 23, 2020

CEU:

CEU: 1.0 – Evolving Topics

Speaker:

Barbara L. Flynn, RHIA, CCS
Vice President and Founder
Code & Comply Specialists

Ms. Barbara Flynn, RHIA, CCS, is the Vice President and Founder of Code & Comply Specialists a nation-wide HIM consulting and compliance consulting firm offering clinical coding services, coding compliance and documentation audits, denials review and appeal, CDI education and HIM management. Code & Comply Specialists is a subsidiary of the FHA Management Corporation and has been providing these services for over 25 years. Barbara has been an AHIMA-approved ICD-10-CM/PCS trainer and Ambassador and is widely recognized as a coding and compliance expert.

Barbara has provided numerous seminars for FHIMA and other organizations on coding and billing compliance, appropriate physician queries, comprehensive documentation integrity, regulatory compliance and many other topics throughout her career. Since 1991, Code & Comply Specialists has provided temporary staffing, interim management, coding and compliance audits and educational sessions and denial management services. Our
team of credentialed American Health Information Management Association (AHIMA) professionals, physicians and legal advisors combine a wealth of knowledge and expertise to ensure cost-effective service solutions to healthcare systems nationwide.

Pricing:

AHIMA Member: $20
Non-Member: $30

Instructions:

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Once the course is completed, you will have the ability to download the CE certificate.

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Course Includes

  • 1 Lesson
  • Course Certificate