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 improvement (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. 

At this four-day course you will learn how 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

Need to train a group?

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