The number of Medicare Part C Risk Adjustment (RA) patients are increasing and are no longer only the domain of physician practices. Hospital inpatient and outpatient settings contribute to the diagnoses collected for Hierarchical Condition Categories (HCCs), yet there is a lack of understanding of how RA works and how HCCs are obtained using ICD-10-CM. CMS estimates that 9.5 percent of payments to Medicare Advantage (MA) organizations are improper, mainly due to unsupported diagnoses. And now, with increased scrutiny from the Office of Inspector General (OIG), ensuring that you and your team understand the foundational basics of HCCs and RA will help to identify areas with documentation and coding that may put you at risk for fraud and loss of revenue.
The bottom line: accurate clinical data is the goal and outcome needed with RA HCCs. And since revenue for providers is always a focal point for operations, having a clear understanding of the health information management (HIM) coding and clinical documentation integrity (CDI) components for RA HCCs is pivotal since diagnosis codes and the severity of the illness will drive the HCC and RA payment.
Accurate and compliant HCC coding starts with a strong knowledge of the basics of the Medicare Part C RA payment model, so register to attend this important webcast – the first in a 2-part series - "Learning Made Easy for Risk Adjustment and HCCs Part 1: Getting the Basics Right."
Click here for information about the two-part series.
Why This is Relevant:
CMS estimates that 9.5 percent of payments to MA organizations are improper, mainly due to unsupported diagnoses submitted by MA organizations. And now, with increased scrutiny from the OIG, ensuring that you and your team understand the foundational basics of HCCs and RA will help to identify areas with documentation and coding that may put you at risk for fraud and loss of revenue.
Take this brief quiz to see if you and your team could benefit from this webcast:
- What does the RAF mean and relate to?
- How many categories are there within Medicare Advantage Risk Adjustment?
- What OIG investigations have focused on RA?
- What specific clinical documentation is needed for the patient encounter to be a valid encounter?
- Understand the history and purpose of Risk Adjustment
- Learn about the Medicare Advantage Risk Adjustment HCC requirements and key definitions
- Recognize Risk Adjustment Factor Score and the financial impact of certain HCCs
- Receive Medicare HCC documentation guidance and advice for capturing ICD-10-CM
- Gain new knowledge regarding diagnosis coding to benefit CDI and coding professionals
Who Should Attend:
Outpatient and Inpatient coders, coding auditors and coding educators, HCC coding staff, clinical documentation integrity specialists (CDISs), coding compliance specialists and managers, hospital emergency department coders, compliance directors, physician office coding staff and revenue cycle managers.
Webcast Access Privileges: Only one login is allowed per webcast purchased. Discounted pricing for additional registrants is available. For more information about webcast pricing and requirements, click here.