January 23, 2020
12:00 PM – 1:00 PM ET

Introduction to Risk Adjustment Documentation & HCC Payment Models brings together hard-to-find information about risk adjustment (RA) coding and hierarchical condition categories (HCCs) in a new comprehensive resource that explains this complex reimbursement methodology. Now your organization will have a guide that provides both the “big picture” and the fine detail needed to document, code, and report essential information so that accurate risk levels are assigned and appropriate reimbursement received.

Originally developed by CMS as a risk-adjusted payment method for Medicare Advantage (MA) plans. HCCs are now used in a variety of value-based reimbursement (VBR) programs. Our new guide helps you navigate the shift from a fee-for-service environment to VBR and provides the tools necessary to ensure risk levels and resources are aligned.

Objectives:

  • Understand risk adjustment coding and HCCs. Three types of HCCs covered under Medicare, CMS-HCC, Rx-HCC, and ESRD/PACE-HCC are explained. HSS-HCCs used for commercial plans.
  • Learn which demographic factors and conditions impact risk. Discover the role chronic conditions play in overall risk adjustment, how the risk adjustment factor (RAF) score is calculated, and how the cumulative RAF score for covered beneficiaries drives payments to health plans.
  • Understand the provider’s role. Documentation and coding are the basis for delineating health status and calculating risk. Use the clinical documentation improvement strategies to increase coding specificity and translate into accurate RAF scores.
  • How RAF scores are calculated. Using case studies to identify conditions that impact health status and cost of care. Calculate RAF scores for patients to quantify risk.

We will cover the following:

  • History and purpose of RAF
  • Key terms definitions
  • Acceptable provider types
  • Payment methodology and timeline
  • Coding and documentation
  • Tools for risk adjustment
  • Coding scenarios
  • Guidance for developing internal risk adjustment coding policies
  • Audits
  • Risk adjustment tables

Suggested Audience

C-suite professionals, CDI specialists, profee billers, RHC managers, HIM managers, and managed care contracting.

Speaker: Barbara L. Flynn, RHIA, CCS