Overview

Learn about the Medicare Risk Adjustment model, including Risk Adjustment Factor (RAF) scores and Hierarchical Condition Categories (HCC), how provider documentation and coding of certain conditions affects the perceived severity of illness of your patients, and your overall rating as a healthcare provider or institution. Explore the proper documentation and coding of several common risk-adjusting diagnoses that present a challenge to providers today either because of existing incorrect documentation habits, differences between clinical and coding language, or increased specificity requirements for ICD-10-CM coding. Attendees will learn the:

  • Importance of capturing an accurate severity of illness in the medical record via proper documentation and coding
  • How this documentation reflects on providers and institutions
  • Differences in clinical and coding language
  • Documentation requirements for risk adjustment
  • Overview of the Medicare risk adjustment model, Risk Adjustment Factor (RAF) and Hierarchical Condition Categories (HCC) with documentation and coding examples

Speaker

Osamah El-Aroud, MD, CRC

Dr. El-Aroud is an ABIM certified internist and AAPC certified risk adjustment coder (CRC). He completed his residency training in 2005 at Oakwood Hospital in Dearborn, Michigan then worked as a hospitalist in the Ann Arbor, Michigan area for 10 years. Dr. El-Aroud became involved with inpatient Clinical Documentation Improvement as the CDI Physician Champion at Chelsea Community Hospital in 2010 and served in that role for 4 years. In late 2014, he joined Tessellate formerly known as Data Driven Delivery Systems (DDDS) as the Medical Director for the Michigan market after the company signed a contract with Blue Cross and Blue Shield of Michigan (BCBSM). Dr. El-Aroud obtained his AAPC Risk Adjustment Coding certification in June 2015, he continues to fulfill the role of Medical Director at Tessellate for the Michigan and Indiana markets with responsibilities including provider education in documentation and coding for risk adjustment as well as performing chart reviews and providing clinical support to various teams within the company.

CEU

1.0 – Clinical Data Management

Date Published

March 7, 2018

Course Content