Conference Description:

Risk Adjustment Documentation and Coding Boot Camp

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Course Overview

Risk adjustment requires coding and CDI professionals to work together as one team to ensure the capture of the most appropriate risk score for each patient.

If you’re looking for ways to expand your CDI department into outpatient settings and services—all of which can impact risk scores—you’ll find it in theRisk Adjustment Documentation and Coding Boot Camp.

The Risk Adjustment Documentation and Coding Boot Camp reviews both inpatient and outpatient coding guidelines and their application to the CMS-Hierarchical Condition Category (HCC) methodology, and includes detailed instruction on the individual HCCs and identification of opportunities for improved documentation. Clinical scenarios are used to demonstrate concepts and validate learning.

This Boot Camp goes beyond just knowing how to code for a condition. It explores where coding information may be obtained as well as where to look for documentation deficiencies to improve overall risk scores. Similar to how implementing clinical documentation improvement (CDI) departments improves documentation for DRG assignment, this Boot Camp uses the same principles to improve documentation for risk adjustment.

The Risk Adjustment Documentation and Coding Boot Camp will take you all the way from tackling the concept of risk adjustment and how it is calculated, to focusing on specific diagnoses and conditions that may affect overall risk scores. It will ensure you understand all facets of risk adjustment and help you position your organization to make the best decisions. It will also offer strategies to reduce your facility’s vulnerability to Risk Adjustment Data Validation audits (RADV).

This three-day course can also help prepare you for the Certified Risk Adjustment Coder (CRC) examination offered through the AAPC.



Who should attend?

CDI specialists

CDI managers and directors

HIM managers and professionals

Inpatient and outpatient coding managers and professionals

Medicare Advantage payers

Quality professionals

Physicians and nonphysician healthcare professionals

Physician practice managers


Learning Objectives

At the conclusion of this educational activity, participants will be able to:

Discuss predictive modeling and the concept of risk adjustment

Explain how risk adjustment is applied to reimbursement in healthcare

Explain how risk adjustment is applied to CMS quality measures

Identify the different models used in risk adjustment

Discuss the process of computing the Risk Adjustment Factor (RAF) score for individuals

Describe the process of Risk Adjustment Data Validation (RADV) audits

Identify elements within a medical record that can be used to support code assignment

Define what is considered a reportable diagnosis

Identify the most common conditions found within the Hierarchical Condition Categories (HCC) risk adjustment methodology

Apply the Official Guidelines for Coding and Reporting when assigning codes to these common conditions

Identify query opportunities related to documentation deficiencies that would likely impact HCC assignment and RAF score

Apply the process of record review for HCC risk adjustment to clinical examples


Outline/Agenda

Module 1: CMS Reimbursement: IPPS, OPPS, and Medicare Advantage Quality Incentives
Summary of Medicare Parts A–D
Inpatient Prospective Payment System (IPPS)
Outpatient Prospective Payment System (OPPS)
Medicare Advantage Plans
Prescription Drug Coverage


Module 2: ICD-10-CM Diagnosis Coding: Documentation Sources, Diagnosis Selection, and Official Guidelines
Sources of Authority for ICD-10-CM Coding
Documentation Sources
Diagnosis Coding—Inpatient Services
Diagnosis Coding—Outpatient/Professional Services
Uncertain Diagnoses
Signs/Symptoms
Comparative/Contrasting Diagnoses
Acute and Chronic Conditions
Combination Codes
ICD-10-CM Conventions
Excludes notes
Laterality


Module 3: Introduction to Risk Adjustment: Review of Risk Adjustment Methodologies
Risk Adjustment Models
HHS-HCCs
Adjusted Clinical Groups
CDPS
DRGs
CMS-HCCs
Demographic Variables
Hierarchical Condition Categories
Applicable settings
Approved providers
Medicare Advantage Plans
Prescription Drug Coverage


Module 4: Hierarchical Condition Categories and the Hierarchies
Review of Key Diagnoses From Each HCC


Module 5: Disease Interactions and Disabled Disease Interactions
Roles of Disease Interactions in Risk Adjustment


Module 6: Risk Adjustment Validation: RADV Audits



Please contact the event manager Marilyn ([email protected] ) below for:
- Multiple participant discounts
- Price quotations or visa invitation letters
- Payment by alternate channels (PayPal, check, Western Union, wire transfers etc)
- Event sponsorships