HCC/Risk Adjustment

Sections to be covered:

What is Risk Adjustment? How Health Insurance Works and Population Health Management

This webinar will enable students to understand why risk adjustment is used and how it was deployed in various healthcare settings. Topics that are covered are the understanding of population health management, different types of insurance coverages, how finances flow through the healthcare system, introductory information on the commercial marketplace Affordable Care Act or Obamacare product, and general tenants of risk adjustment for each of the different models that are most widely used to include: Medicare HCC, Health and Human Services HCC, and Medicaid CDPS risk adjustment models.

Basics of Risk Adjustment

• Tenants
• Rules
• Basic Coding Guidelines

This webinar will cover the basics of risk adjustment programs to include their shared and differing rules and how diagnosis codes are linked to HCC values or CDPS values. We will cover coding guidelines, some of the guidelines from the Coding Clinic® of the American Hospital Association, as well as CMS and HHS guidance. Information about similarities and differences of risk adjustment models will also be covered. We will also cover the differences between risk adjustment from traditional fee-for-service coding methodologies.

Documentation Challenges in Risk Adjustment

• Frequent Problems
• How to Navigate

This webinar will cover common challenges in clinical documentation and how these relate to coding for risk adjustment purposes. Topics will include important language variations and their impact on diagnosis code selection as well as the necessity for provider querying when necessary and when possible depending upon the reviewers workplace situation. Tips will be offered to assist with provider education on clinical documentation improvement.

Practical Examples

This webinar will take a series of practical examples parsed from actual clinical documents that have been desensitized to help illustrate basic core understandings of what may or may not be coded and what the reasoning behind those rules are when coding in risk adjustment settings.

About The Author

Brian Boyce, CPC, CPC-I
Mr. Boyce has spent the last five years dedicated to risk adjustment, and specifically the Medicare utilization of the HCC model. He has worked on the National level with a high profile company as Vice President of Clinical and Coding Services that served Medicare Advantage plans in the risk adjustment arena. He has spoken on the National circuit at risk adjustment events to include CMS conferences, and has attended official RADV (Risk Adjustment Data Validation) training at CMS headquarters in Baltimore, MD. Brian is regularly contacted by coders from virtually every big player in the risk adjustment market for his opinions, advice, and expertise.