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Affordable Care Act (ACA) continues to be a hot topic in the current political climate. Passed in 2010, it sets forth a commercial risk adjustment payment model based on diagnostic coding. With coding at the forefront of this payment methodology, now is the time to get current with commercial risk adjustment regulations. This presentation will begin with a regulatory overview by attorney Toshi Barks, and will continue with an in-depth review of how the coding impacts the model, as well as the government's audit process for ensuring payment accuracy presented by coding expert Melissa Ferron.
At the conclusion of this presentation, participants will understand:
• Overview of relevant ACA provisions for coding & HIM professionals
• Commercial Risk Adjustment Model: Condition categories identified as high risk
• HHS-Operated Risk Adjustment Data Validation (HRADV) audit process
• How to become an Initial Validation Audit (IVA) entity
• Requirements for IVA entities, Senior Coders, & Primary Coders
• Six stages of HRADV audit process
• In-Depth look at health status validation through diagnostic coding
• InterRater Reliability (IRR) measurement of coder accuracy
Who Should Attend
Health Information Managers, Chief Financial Officers, Quality/Performance Improvement Professionals, Physician Practice and HIM Coding Directors/Managers, Coding Professionals, Coding Compliance Professionals, Coding Consultants, Coding Auditors, Medicare Advantage Organizations.
This program has been approved for two continuing education units (CEUs) for use in fulfilling the continuing education requirements of the American Information Management Association (AHIMA). AAPC: AHIMA CEUs are accepted from programs sponsored by AHIMA national offices and the state AHIMA branches hour for hour; program approved for two CEUs. Provider approved by the California Board of Registered Nursing; provider number 05474 for two contact hours. Certificates of attendance will be provided upon completion of event evaluation. HIM Domain: Domain type(s): External Forces. Event Number WEB122