Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version

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Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version

Product Code: RAPV

This can’t-miss education equips payer professionals with the knowledge they need to identify overpayments or catch issues of fraudulent or abusive billing practices.

Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version

Course Overview

Looking for payer-specific resources? We have them!

Payer-specific risk score training from HCPro, the most trusted name in coder education

The Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version is the ideal choice for payer professionals looking for training on risk-adjusted coding. This can’t-miss education equips payer professionals with the knowledge they need to identify overpayments or catch issues of fraudulent or abusive billing practices.

This boot camp will help you to:

  • Gain a detailed understanding of risk adjustment and identify diagnoses and conditions that affect risk scores
  • Utilize the Official Guidelines for Coding and Reporting to understand appropriate code assignment
  • Recognize reportable diagnoses and identify elements to support code assignment

Payer professionals will leave this boot camp with an understanding of:

  • CMS HCC and risk adjustment scoring
  • Risk adjustment’s role in reimbursement and CMS quality measures
  • The Official Guidelines for Coding and Reporting, as well as identify correct codes for common diagnoses
  • What to look for in documentation to support accurate risk score capture and clinical validation

The Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version helps payer professionals understand the concepts of risk adjustment, how risk scores are calculated, how to ensure reportability, and the clinical and diagnostic support needed for impactful diagnoses. It ensures understanding of all facets of risk adjustment and helps position organizations to make the best decisions.

This isn't just any coding course. See the HCPro difference for yourself!

  • Expertly designed course materials: Course materials are developed by adult education experts. The curriculum uses a “how to” approach where participants learn how to apply concepts that they can then customize to their organizational needs. Content is regularly updated based on changing industry practices and participant feedback.
  • Live instruction: Classes are taught by credentialed, experienced instructors with decades of experience.
  • Small class size: We limit the number of course participants in order to maintain a low participant-teacher ratio. This allows us to provide individual instruction as needed when participants find a topic particularly challenging; it also allows time for discussion.
  • Well-established program: HCPro is the nation's first organization to offer boot camp training courses to healthcare coding professionals. We have more than 20 years of experience teaching coders, and on average, participants rate this course 4.9 on a 5.0 scale.

Need to train a group?
Bring our industry-leading instructors to your organization to teach one of our existing boot camps or a program customized specifically for your organization.

In addition to best-in-class regulatory and compliance education, hosting an on-site class gives your staff:

  • Access
    Our instructors are all yours, so you can ask them questions and apply concepts specific to your organization.
  • Consistency
    Bring staff together to hear the same message—everyone leaves with the same understanding of the regulations.
  • Unmatched knowledge
    Each instructor has years of both in-the-field and adult education experience. They know exactly how to simplify the complex issues facing your staff.


For more detailed information about HCPro's Boot Camps, contact customer service at 800-650-6787 or email customer@simplifycompliance.com.


Looking to train your whole team? We can bring our expert instructors to you! Learn more here!

Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version

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
    • Disease interactions
  • Medicare Advantage plans
  • Prescription drug coverage


Module 4: Hierarchical Condition Categories and the Hierarchies

  • Review of key diagnoses from each HCC
  • Roles of disease interactions in risk adjustment


Module 5: Compliant Query Practice

Module 6: Risk Adjustment Validation: RADV Audits


Course Agenda/Outline subject to change.

Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version

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 healthcare reimbursement
  • 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 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

Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version

Questions/Answers

What is the focus of the Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version?
This course delves into the goals and intent of various risk adjustment methodologies. It offers an in-depth review of the CMS-HCCs, including how risk adjustment scores are assigned.

What is the live virtual class format?
The live virtual boot camp is instructor-led education that can be accessed from the comfort of your home. Classes are led by our expert instructors, typically take place over the course of four days, and allow instructor/student interaction and engagement.

How long does the course last?
The live virtual course runs from 11:30 a.m. ET/8:30 a.m. PT until 5:30 p.m. ET/2:30 p.m. PT Monday–Thursday, four days in total. Each day involves six hours of education plus breaks.

What computer setup do I need to attend the course?
This course will be hosted on the GoToMeeting® platform. You should have access to a computer that has a microphone and speakers to participate. There is also an option to dial in over a phone line if you need to connect on your phone. You can read the full system requirements for GoToMeeting by visiting https://support.goto.com/meeting/help/system-requirements-for-attendees-g2m010003. You can also test your system by visiting https://support.logmeininc.com/gotomeeting/get-ready.

Does HCPro offer the Live Virtual Risk Adjustment Documentation and Coding Boot Camp®—Payer Version as an on-site course?
In addition to our open registration courses, we also offer this boot camp as an on-site program (with a substantial discount) for organizations that have a number of employees who need training. For more information on hosting an on-site, call 800-780-0584 or click on “Train Groups On-Site.”

What if I need to cancel or transfer my registration?
Please click here to view our cancellation policy.

Who typically attends this boot camp?
This course benefits coders and professionals in the payer setting who administer risk-adjusted plans.

Risk adjustment concepts from the course can also be applied by professionals who monitor quality measures related to the Hospital Value-Based Purchasing (HVBP) Program and the Physician Quality Reporting System (PQRS).

What material does the course cover?
To view the course outline, click on the Course Outline tab above.

Does the course require any previous experience or training?
The course is intended as an introduction to risk adjustment methodologies. It is highly recommended that attendees have existing knowledge of basic diagnosis code assignment as well as basic principles of CDI.

This course is NOT intended to teach coding or basic CDI principles.

Does completion of the course lead to any formal certification?
The AAPC offers the Certified Risk Adjustment Coder (CRC™) examination. For more information, see https://www.aapc.com/certification/crc/.

Does HCPro ever share contact information (e.g., name, address, phone number, email address, etc.) with other companies?
Historically, we have not shared contact information with anyone outside of our company. However, it is possible that at some point we might share contact information with other companies that offer products and services we think would be of interest to our customers. If you would like us to keep your contact information confidential, please let us know so that we can flag your information in our customer database as “Do Not Share.”

How do I get more information?
Contact our sales team at 615-724-7200 or email PD-IS@SimplifyCompliance.com.