Webinar on Demand: Medicare Advantage HCCs and RADV Audits
CHIA Product Code: WEB113
Webinar Date: April 20, 2017
About Webinars on Demand:
CHIA offers Webinars on Demand, which are available for purchase* after the live Webinar has been presented. This convenient format consists of the full 60-90 minute recorded presentation, distributed handout, and accompanying Continuing Education Unit (CEU) Certificate. Each Webinar on Demand is only available for purchase and access for one year after the original recording date.
After purchase, a Purchase Confirmation will be sent to the purchaser’s primary email address. It contains links to access the Webinar presentation using a streaming or download format. Also included will be the handouts and CEU Certificate links. Participants are encouraged to use the handouts while following the presentation.
*Sold separately from the live Webinar.
The Centers for Medicare & Medicaid Services (CMS) developed the Hierarchical Condition Category (HCC) model; a risk-adjustment model used to calculate risk scores to adjust capitated payments made for aged and disabled beneficiaries enrolled in Medicare Advantage (MA) plans and certain demonstrations.
This presentation will provide an in-depth review of the HCC risk adjustment model and will include information to enhance the participant’s understanding of the model. Resources will also be reviewed that can be utilized to help professionals design an internal program to ensure the completeness, accuracy, and integrity of the HCC data collection, reporting, and auditing. In addition to the HCC model, this presentation will also provide a review of the CMS Risk Adjustment Data Validation (RADV) audits on patients' medical records, including objectives, processes, impacts, and available appeal processes.
At the conclusion of the presentation, participants will understand:
• The results from a study using a multi-site dataset of approximately 400,000 patient records with confirmed duplicates
• Acronyms associated with the CMS HCC model
• The framework of the CMS HCC risk-adjustment model for MA
• Hierarchical HCCs and additive HCCs
• The two HCC data reporting mechanisms required by CMS and their impact on prospective payment amounts
• The RADV audits distinguishing between the National RADV and
• Contract-Level RADV audits
• Sampling methodology for RADV audits
• Documentation requirements and allowable HCC documentation sources
• Filtering logic for acceptable HCC diagnoses
• The benefits of an internal HCC audit program
Independent Consultant, Franklin Consulting
Janet Franklin, RHIT, CCS, CCS-P, AHIMA-Approved ICD-10-CM/PCS Trainer
Janet Franklin has 30 years of progressive experience in hospitals, healthcare systems, and regulatory oversight entities with core competencies in coding compliance, information systems, health information management, audit design and performance, and educational program development and presentation. She has a thorough understanding of multiple reimbursement methodologies including Medicare Risk Adjustment, Commercial Risk Adjustment, MS-DRGs, APCs, and RBRVS.
Health Information Managers (HIM)/Directors and Supervisors, Quality/Performance Improvement professionals, Physician Practice Managers and Staff, Patient Access and Registration Supervisors/Managers, Privacy professionals, Compliance Managers and Staff, Information Technology Supervisors, Clinical Informatics professionals, and Health Data Analysts.
WHO SHOULD ATTEND:
This program is approved for 2 CEUs by AHIMA, AAPC and BRN. HIM Domain: Clinicial Data Management.