Risk Adjustment Documentation and Coding Boot Camp

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Risk Adjustment Documentation and Coding Boot Camp

Product Code: OCBC

Going beyond just knowing how to code for a condition... This Boot Camp explores where coding information may be obtained as well as where to look for documentation deficiencies to improve overall risk scores.


Interested in this class? Contact us to be put on a notification list when a new date is added at
PD-IS@SimplifyCompliance.com

This live boot camp is best for those looking for an interactive learning experience. Classes are led by our expert instructors, take place over the course of a week, and allow instructor/student interaction and engagement.

Risk Adjustment Documentation and Coding Boot Camp

Course Overview

Risk score training beneficial for both Coding and CDI professionals

Risk adjustment requires coding and CDI professionals to work together as one team to ensure the capture of the most appropriate risk score for each patient.

If you’re looking for ways to expand your CDI department into outpatient settings and services—all of which can impact risk scores—you’ll find it in the Risk Adjustment Documentation and Coding Boot Camp.

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

This course applies the core concepts of Clinical Documentation Integrity related to record review and provider education, allowing both coding professionals and CDI specialists to accurately capture a patient’s complexity and accurate risk scoring.

The process of risk adjustment accounts for known health conditions, allowing for comparison of wellness amongst patients. Most risk adjustment models utilize diagnosis codes to determine potential risks. The variables pulled from documentation can assist in identification of those patients with a higher medical need than others. The process of risk adjustment is used to predict both costs and allow for comparisons related to quality-of-care measures.

This course reviews various risk adjustment methodologies with a deep focus upon CMS Hierarchical Condition Categories. A review of risk score calculation and those diagnoses/conditions that offer impact will assist your efforts and success is risk adjustment reporting.

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 a reportable diagnosis and identify elements to support code assignment
  • Assist providers in strong documentation in support of successful audit results


Leave this boot camp with an understanding of:

  • Risk adjustment’s role in reimbursement and CMS’s quality measures
  • CMS HCC and risk adjustment scoring
  • The CAP- Official Guidelines for Coding and Reporting, as well as what the correct codes are for common diagnoses that affect your risk score
  • Strong documentation in support of RADV audits
  • Documentation requirements to support accurate risk score capture
  • The 2021 Coding Guidelines and new HCC mappings


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: Attendees complete a set of exercises/case studies after appropriate modules to ensure that they understand the concepts and know how 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 CDI education director at HCPro, Laurie Prescott.

Need Coding education?

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


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

Risk Adjustment Documentation and Coding Boot Camp

Outline/Agenda

Module 1: Introduction to CMS Reimbursement

  • Summary of Medicare Parts A-D
  • Inpatient Prospective System (IPPS)
  • Outpatient Prospective System (OPPS)
  • Medicare Advantage Plans
  • Prescription Drug Coverage


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 diagnoses
  • Acute and chronic conditions
  • Combination codes
  • ICD-10-CM conventions


Module 3: Introduction to Risk Adjustment

  • Risk Adjustment Models
    • HHS- HCCs
    • CDPS
    • Elixhauser Comorbidities
    • DRGs
    • CMS-HCCs
  • Demographic Variables
  • Hierarchical Condition Categories
    • Applicable Settings
    • Approved Providers
    • Hierarchies
    • Disease & Disabled Interactions
  • Medicare Advantage Plans
  • Calculating a Risk Score
  • The Role of Disease Interactions


Module 4: The “Hierarchies”


Module 5: Risk Adjustment Data Validation Audits (RADV)

  • 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: 

  • Discuss predictive modeling and the concept of risk adjustment 
  • Explain how risk adjustment is applied to reimbursement in healthcare 
  • 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 Hierarchical Condition Categories (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

Risk Adjustment Documentation and Coding Boot Camp

Continuing Education

Association of Clinical Documentation Integrity Specialists (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).

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.

American Health Information Management Association (AHIMA)
This program has been approved for 22 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

Accreditation Council for Continuing Medical Education (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

American Nurses Credentialing Center (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.

California Board of Registered Nursing 
HCPro is approved by the California Board of Registered Nursing to provide 27 nursing contact hours. California BRN Provider #CEP 14494. 

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

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, 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 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 615-724-7200 or email PD-IS@SimplifyCompliance.com.