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Risk Adjustment Documentation and Coding Boot Camp

HC Pro
6 hrs

Risk Adjustment Documentation and Coding Boot Camp

HC Pro
6 hrs

Library Overview

The Risk Adjustment Documentation and Coding Boot Camp Online goes beyond just knowing how to code for a condition. It explores where to obtain coding information as well as where to look for documentation deficiencies to improve overall risk scores. Similar to how implementing a clinical documentation improvement (CDI) department strengthens documentation for DRG assignment, this Boot Camp uses the same principles to improve documentation for risk adjustment.Risk adjustment uses diagnoses and patient demographics to calculate a payment amount for a beneficiary for a defined period. The methodology focuses on how sick the patient is, rather than how often the patient is seen or evaluated by a provider. Payments are linked directly to the documented conditions in the medical record, not to the number of visits.The Boot Camp will take you all the way from tackling the concept of risk adjustment and how it is calculated, to focusing on specific diagnoses and conditions that may affect overall risk scores. It will ensure you understand all facets of risk adjustment and help you position your organization to make the best decisions.

Library Objectives

At the conclusion of this library, 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

Contributor Bios

Laurie L. Prescott, MSN, RN, CCDS, CDIP, CRC, is the CDI education director with HCPro. Prescott serves as a full-time instructor for the CDI Boot Camp as well as a subject matter expert for the Association of Clinical Documentation Improvement Specialists (ACDIS).Prescott is a frequent speaker on HCPro/ACDIS webinars and author of The Clinical Documentation Improvement Specialist’s Complete Training Guide. She started her nursing career in 1985 as a graduate of the University of Vermont School of Nursing. Since that time she has worked at a variety of organizations, including academic, large, and small community hospitals. She has worked in a number of nursing roles, including as manager in the areas of medical/surgical, ICU, PACU, and endoscopy. Her experience also includes specialization as a compliance officer.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.

Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, and Director of HIM and Coding. Shannon McCall directs all of HCPro’s Certified Coder Boot Camp® programs. She is the developer of the Certified Coder Boot Camp®—Inpatient Version and the Evaluation and Management Boot Camp®. Most recently she collaborated with the CDI team to develop the Risk Adjustment Documentation and Coding Boot Camp®. As a consultant for HCPro, she works with hospitals, medical practices, and other healthcare providers on a wide range of coding-related issues with a particular focus on education, coding reviews, and audits.McCall has extensive experience with coding for both physician and hospital services. Prior to joining HCPro, she worked for a national medical practice management company, where her duties included serving as a client manager and an in-house coding trainer. She also previously worked for a national consulting firm focusing on hospital inpatient, outpatient, and ER services.McCall is accredited as a Registered Health Information Administrator, a Certified Coding Specialist, and a Certified Coding Specialist–Physician by the American Health Information Management Association (AHIMA), and is an AHIMA-approved ICD-10-CM/PCS instructor. She is also accredited as a Certified Evaluation and Management Coder, a Certified Professional Coder, and a Certified Risk Adjustment Coder, and is an AAPC-approved instructor of the Professional Medical Coding Curriculum. Additionally, she is a Certified Clinical Documentation Specialist and has served on the Advisory Board of the Association of Clinical Documentation Improvement Specialists (ACDIS). McCall holds a Bachelor of Science in Health Information Administration from the Medical University of South Carolina.


Who should attend?

  • CDI specialists
  • CDI managers and directors
  • HIM managers and professionals
  • Inpatient and outpatient coding managers and professionals
  • Medicare Advantage payers
  • Quality professionals
  • Physicians and non-physician healthcare professionals
  • Physician practice managers

Accreditation Statements for the library as a whole

NOTE: Credits are only offered after completion of all courses and the final exam.

AAPC: This program has the prior approval of AAPC for 5.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

AHIMA: This program has been approved for 5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

ACDIS: This program has been approved for 7.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification, offered as a service of the Association of Clinical Documentation Improvement Specialists (ACDIS).

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 7.5 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity

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 7.5 nursing contact hours is provided by HCPro.

CA Board of Nursing: HCPro is approved by the California Board of Registered Nursing to provide 9 nursing contact hours. California BRN Provider #CEP 14494.

Library Contents
CMS Reimbursement: IPPS, OPPS, and Medicare Advantageinteractive
ICD-10-CM Diagnosis Coding: Documentation Sources, Diagnosis Selection, and Official Guidelinesinteractive
Introduction to Risk Adjustment: Review of Risk Adjustment Methodologiesinteractive
Hierarchical Condition Categories and the Hierarchies (part 1)interactive
Hierarchical Condition Categories and the Hierarchies (part 2)interactive
Disease Interactions and Disabled Disease Interactionsinteractive
Risk Adjustment Validation: RADV Auditsinteractive
Additional Practiceinteractive
Final Examinteractive