Risk Adjustment and HCCs: More Than an Outpatient Concern - On-Demand

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Risk Adjustment and HCCs: More Than an Outpatient Concern - On-Demand

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Risk Adjustment and HCCs: More Than an Outpatient Concern

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Available ON-DEMAND

Presented on: 
Thursday, April 4, 2019 

Presented by: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC and Allen Frady, RN, BSN, CCDS, CCS, CRC

Sponsored by: Association of Clinical Documentation Improvement Specialists (ACDIS)

Only 13% of ICD-10-CM diagnosis codes are classified as Hierarchical Condition Categories (HCC), so if CDI professionals are tasked with reviewing for risk adjustment, they need to understand the required specificity and diagnoses that affect the patient’s risk adjustment score.

Risk adjustment primarily uses diagnosis codes related to chronic diseases to heighten reimbursement for sicker patients. CDI staff need to help capture the documentation of these conditions annually to contribute to a patient’s risk score. They must be documented consistently throughout the medical record, regardless of whether the patient is seen in the inpatient or outpatient setting.

Join expert instructors Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, and Allen Frady, RN, BSN, CCDS, CCS, CRC, for this 90-minute discussion of the ins and outs of HCCs and risk adjustment methodologies and learn how to apply the principles of everyday CDI chart reviews via in-depth case studies.

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

  • Explain how risk adjustment is applied to reimbursement in healthcare
  • Explain the CMS-HCC methodology
  • Identify documentation improvement opportunities for HCC capture
  • Apply risk adjustment methodology to CDI reviews
  • Educate physicians on the importance of risk adjustment and HCC capture


  • CMS reimbursement overview
    • Medicare Part A, B, and C
  • CMS-HCC risk adjustment methodology
    • Relative factors
    • Calculating risk scores
  • Applying risk adjustment methodology to CDI chart reviews
    • Neoplasms
    • Malnutrition
    • Psychiatric diagnoses
    • Spinal conditions
    • Vascular conditions
    • Pneumonia
  • HCC capture for inpatient versus outpatient CDI


  • Sample queries
  • HCCs and the hierarchies

Who Should Listen?

  • CDI specialists
  • CDI managers/directors
  • HIM managers/directors
  • Inpatient coders
  • Physician advisors
  • Outpatient coders

Meet the Speakers

Laurie Prescott
Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC,
is the CDI education director at HCPro in Middleton, Massachusetts, an instructor for the CDI suite of boot camps, and a subject matter expert for ACDIS. She serves on the ACDIS Advisory Board and the CCDS-O Certification Committee. A frequent speaker for webinars and the author of The CDI Specialist’s Complete Training Guide, Prescott has been in the nursing field since 1985 and developed a CDI program at her facility prior to joining HCPro in 2013. Her experience also includes specialization in the role of compliance officer.


Allen Frady
Allen Frady, RN, BSN, CCDS, CCS, CRC,
is a CDI education specialist for HCPro, and serves as an instructor for ACDIS’ various CDI Boot Camps. Frady has 12 years’ experience as a coding and CDI consultant. He spent two years as a coding director at the Medical College of Georgia, and has experience in case management, step-down ICU, and cardiac telemetry. He has conducted CDI education for systems such as Dignity Health, HSHS Hospital Systems, and Thomas Jefferson University. 



Continuing Education

(Live + On-Demand) This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

Ability to claim credits for this webinar expires on: 04/03/2020


Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

No problem. The On-Demand version will be available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $259 value! 

Participation in the webinar is just $259 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email customerservice@hcpro.com if you have questions.