Risk Adjustment Documentation and Coding Boot Camp

Course Overview

Risk adjustment training for both coding and CDI professionals

Risk adjustment methodologies require coding and CDI professionals to work together as a team to ensure the capture of the most appropriate risk score for each patient. If you're looking to expand your CDI department's impact related to HCC capture or expand into the outpatient setting, you'll find direction in the Risk Adjustment Documentation and Coding Boot Camp.

The Risk Adjustment Documentation and Coding Boot Camp addresses not only compliant coding practices, but also the reporting requirements related to valid risk adjustment scoring.

This course applies the core concepts of CDI related to record review and provider education, allowing both coding professionals and CDI specialists to accurately capture a patient's complexity and risk score.

The process of risk adjustment accounts for known health conditions, allowing for comparison of wellness among patients. Most risk adjustment models use diagnosis codes to determine potential risks; thus, the variables pulled from documentation can help identify patients with especially high medical needs. The process of risk adjustment is used both to predict costs and to allow for comparisons related to quality-of-care measures.

This course reviews various risk adjustment methodologies with a deep focus on CMS Hierarchical Condition Categories (HCC). It reviews risk score calculation and diagnoses/conditions that offer impact. 

Who should take this course? 
This course benefits professional coders, CDI specialists, directors and managers of HIM and CDI, providers, physician practice managers, revenue cycle staff, and professionals in the payer setting who administer risk-adjusted plans. Risk adjustment concepts from this class can also be applied by professionals who monitor quality measures related to the Hospital Value-Based Purchasing (HVBP) Program and Physician Quality Reporting.

This Boot Camp will help you to:

• Have a detailed understanding of risk adjustment and identify diagnoses and conditions that affect risk scores
• Utilize the Official Guidelines for Coding and Reporting to assign codes
• Recognize reportable diagnoses and identify elements to support code assignment
• Assist providers in writing strong documentation that stands up to audits

Leave this Boot Camp with an understanding of:

• Risk adjustment's role in reimbursement and CMS quality measures
• CMS-HCC and risk adjustment scoring
• The Official Guidelines for Coding and Reporting, as well as required documentation in support of code assignment
• Strong documentation in support of RADV audits
• Documentation requirements to support accurate risk score capture
• Required specificity to support HCC assignment

See the HCPro difference for yourself!

• Expertly designed course materials: Materials are developed by our instructors specifically for this intensive learning format.;
• Hands-on learning: Exercises and case studies to ensure understanding of the concepts and the ability to apply them to real-world situations.
• Small class size: Class size is limited to ensure individual attention.
• Nationally recognized educators: HCPro is the nation's premier organization offering Boot Camp training courses to healthcare coding professionals.

Our Boot Camps are a comprehensive and effective way to strengthen your understanding of CDI. “Our goal as instructors is to offer detailed, thorough, and timely education that can be simply broken down and easily understood and applied in daily practice,” says Deanne Wilk, CDI education director at HCPro.

Need coding education?
For best-in-class coding education, find out more about our Boot Camps: https://hcmarketplace.com/product-type/boot-camps/coding.

For more detailed information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

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

Risk Adjustment Documentation and Coding Boot Camp

Course Outline

Module 1: Introduction to CMS Reimbursement

• Summary of Medicare Parts A–D
• Inpatient Prospective Payment System (IPPS)
• Outpatient Prospective Payment System (OPPS)
• Medicare Advantage plans
• Prescription drug coverage
• Q&A and discussion

Module 2: Diagnosis Selection and Documentation

• 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 diagnose
• Acute and chronic conditions
• Combination codes
• ICD-10-CM conventions
• Q&A and discussion

Module 3: Introduction to Risk Adjustment

• Risk adjustment models
  • HHS-HCCs
  • CDPS
  • Elixhauser comorbidities
  • DRGs
  • CMS-HCCs
• Demographic variables
• HCCs
  • Applicable settings
  • Approved providers
  • Hierarchies
  • Disease and disability interactions
• Medicare Advantage plans
• Calculating a risk score
• The role of disease interactions

Module 4: The Hierarchies

• A comprehensive review of the condition categories and hierarchies, each with a review of:
  • Significant conditions with diagnostic considerations
  • Chapter-specific coding guidance and documentation requirements
  • Examples of MEAT (Monitor, Evaluate, Assess, and Treat)

Module 5: Risk Adjustment Data Validation (RADV) Audits

• Historical necessity for RADV audits 
  • OIG Work Plan 2017–2018
  • Fraud investigations
  • What is a RADV audit?
  • Impacts of RADV audits
  • RADV submission requirements/checklists
  • Querying for clinical validity
  • Internal auditing/reviews

Module 6: Compliant Query Practice

*Course Outline/Agenda subject to change.

Risk Adjustment Documentation and Coding Boot Camp

Learning Objectives

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

• Describe the relationship between risk adjustment and healthcare reimbursement
• Identify CMS quality measures that are impacted by risk adjustment
• Identify the models used in risk adjustment
• Compute the CMS-HCC Risk Adjustment Factor (RAF) score for individuals
• Obtain strong documentation in support of RADV audits
• Identify elements within a medical record to support code assignment
• Clinically validate the most common conditions within the HCC risk adjustment methodology
• Apply the Official Guidelines for Coding and Reporting when assigning codes to common conditions
• Identify query opportunities related to documentation deficiencies that would likely impact HCC assignment and RAF score
• Review health records and accurately capture patients’ risk adjustment scores

Continuing Education

AAPC
This program has the prior approval of AAPC for 22.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

ACCME
HCPro is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

HCPro designates this educational activity for a maximum of 22.5 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity

ACDIS
This program has been approved for 22.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

AHIMA
This program has been approved for continuing education unit(s) (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting of Approved CEUs from AHIMA does not constitute endorsement of the program content or its program provider.

ANCC
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 22.5 nursing contact hours is provided by HCPro.

Disclosure Statement: 
HCPro has confirmed that none of the faculty/presenters, planners, or contributors have any relevant financial relationships to disclose related to the content of this educational activity.

Risk Adjustment Documentation and Coding Boot Camp

Things to Know Before Attending Class

Directions and Hotel Information

The hotel address, phone number, URL, room rate and room rate cut-off date are posted on the Locations/Dates tab. The hotel websites give detailed directions to the hotel as well as information about the location. Please call the hotel directly to make a room reservation. Be sure to identify yourself as an HCPro Boot Camp participant. Please be sure to make your reservation before the cut-off date. After the cut-off date, contact the hotel to determine room availability and rates.

ICD-10-CM Manual

As a part of this class, you will be working in-class exercises requiring code assignment. It is highly suggested that you have an ICD-10-CM manual to participate in this course.

2024 ICD-10-CM for Hospitals
https://hcmarketplace.com/2024-icd-10-cm-hospitals-payers

OR if you are a professional services coder, you may prefer

2024 ICD-10-CM for Physicians
https://hcmarketplace.com/2024-icd-10-cm-physicians

Classroom Time

It is an understatement to say that this course is intense. Other than breaks, we will be in class from 8:00 a.m. to 5:00 p.m. Monday to Wednesday. There will be a lunch break each day. If the class gets behind, it may run later than 5:00 p.m.  

Lunch

We will take a break for lunch each day. Although we typically provide coffee in the morning and drinks and snacks in the afternoon, everyone is on their own for lunch. Note that many hotels do not have restaurants on-site. If you are flying to the course, we generally recommend renting a car.

What to Bring to Class

We recommend you bring the following to all classes:

• Your current ICD-10-CM manual (highly suggested)
• Notepaper
• Sticky notes/flags
• Pen/pencil
• Highlighter
• Layered clothing (e.g., light sweater, light jacket, etc.)

Course Materials

The course materials used in connection with the Risk Adjustment Documentation and Coding Boot Camp® have been specifically designed for use with this course. We have invested a tremendous amount of time, money, and effort in developing, refining, and maintaining these materials. As a course participant, you will receive a complete copy of our materials. However, we do not permit our materials to be used for any purpose other than in direct connection with your participation in this course or as a personal reference in your day-to-day work.

Our instructors demonstrate where to find many resources on the CMS website. If you have access to a laptop or tablet, you may bring it to class to follow along, but you may wish to consider the power and wireless needs of your device. Many conference rooms do not have electrical outlets or charging ports situated conveniently to the tables, so you may wish to ensure you have sufficient battery power. HCPro does not purchase group wireless access for the conference rooms, but many hotels provide free wireless access. You may wish to confirm your connectivity options prior to arriving at the hotel. Please be courteous in your use of electronic devices. Use of electronic devices should not disrupt the class or disturb other participants. HCPro is not responsible for lost, stolen, or damaged devices. Maintaining the security and safety of your device is your responsibility. Cell phone use during class is strictly prohibited.

Business attire is not necessary. Please dress comfortably. Also, we find that the classrooms are sometimes on the cool side, even during the warmer months. You may be more comfortable if you bring a sweater or sweatshirt in case you get cold.

You will receive a complete copy of our course materials at the beginning of class. The materials used in connection with this course were custom designed by our company specifically for use in connection with this course. We have invested a tremendous amount of time, money and effort in developing, refining and maintaining these materials and they are protected by copyright laws. Course materials may not be duplicated. You may use the materials (i) in direct connection with the course or (ii) as a personal reference in your day-to-day work. No claim is asserted to any U.S. Government, American Medical Association, or American Hospital Association works included in the course materials workbook. 

For our cancellation and transfer policy, visit our website: https://hcmarketplace.com/cancellations

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

We Look Forward to Having You In Class!

Risk Adjustment Documentation and Coding Boot Camp

Questions/Answers

What is the focus of the Risk Adjustment Documentation and Coding Boot Camp? 
This course delves into the goals and intent of various risk adjustment methodologies. It will offer an in-depth review of the CMS Hierarchical Condition Categories (HCC), including how risk adjustment scores are assigned and the process of Risk Adjustment Data Validation (RADV) audits. The Boot Camp will discuss how coding and clinical documentation integrity (CDI) professionals can affect these processes.

The Official Guidelines for Coding & Reporting will be reviewed as it relates to risk adjustment diagnosis coding. This course will review correct coding for common diagnoses that can impact your risk scores. It will identify opportunities for query and further clarification, and offer tips for provider education.

Does HCPro offer this Boot Camp as an on-site? 
In addition to our open registration courses, we also offer the 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? 
To view our cancellation policy, click here. 

Who typically attends this Boot Camp? 
This course benefits professional coders, CDI specialists, directors and managers of HIM and CDI, providers, physicianICD practice managers, revenue cycle staff, and professionals in the payer setting who administer risk-adjusted plans

Risk adjustment concepts from this class 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 "Course Outline" above.

Does the course require any previous experience or training? 
The course is intended as an introduction to risk adjustment methodologies and the application of coding and CDI practices to capture accurate risk adjustment. 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/.

How is the course taught? 
The course is taught using a combination of lecture, class discussion, and hands-on exercise/case studies.

What do I need to bring to class? 
When you arrive at class, you will receive an extensive notebook of course materials. In addition, please bring the following to all classes: 

• Current ICD-10-CM Manual
• A highlighter 
• A notebook for taking notes 
• Sticky notes/flags 
• A pen/pencil 

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 that 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." 

Does completion of this course assist with preparation towards formal certification?
ACDIS CCDS-O offers a CDI certification related to the outpatient setting. This course will assist in preparation related to exam objectives that focus on risk adjustment.

How do I get more information? 
Contact our sales team at 800-650-6787 or email sales@hcpro.com.