CMS Guidelines on HCC Coding, Auditing and Regulatory Requirements

Event Information
Product Format
Prerecorded Event
Victoria M. Hernandez, RHIA, CDIP, CCS, CCS-P, AHIMA-Approved ICD-10-CM/PCS Trainer Founder, Integrity Coding Solution
60 minutes
Product Description

Get Insights on HCC Coding and Auditing Guidelines and Regulatory Requirements

The Centers for Medicare and Medicaid Services (CMS) have specific requirements on submissions involving risk adjustment data, which includes HCCs. Coding and auditing errors can greatly impact a health care organization’s revenue cycle.

Join this session, where healthcare expert Victoria M. Hernandez will provide an overview of the guidelines and references that impact HCC coding and auditing best practices, which ensure alignment with regulatory requirements. You will learn about the key areas where errors on HCC coding and auditing may be avoided, focusing on the accuracy and integrity of risk adjustment data. You will receive the latest CMS-HCC and HHS-HCC models, the latest coding guidelines and coding references applicable to HCC diagnoses, and resources for best practices involving HCC audits.

Session Objectives

This session will help you learn about:

  • The two different HCC models
  • The various resources available for HCC auditing best practices
  • Documentation requirements aligned with coding guidelines and regulatory requirements
  • The requirements of an ideal HCC auditor

Session Highlights

This session will discuss:

  • The HCC risk adjustment model
  • The best practices on HCC coding and auditing to ensure alignment with regulatory updates
  • How to accurately identify HCC coding and auditing error rates
  • Case examples involving HCC coding and auditing
  • Regulatory directives applicable to coding including CMS risk adjustment data validation (RADV) audits

Session Agenda

This session will cover:

  • Risk adjustment
    • Background
    • Process
  • Overview of Medicare advantage payment risk areas and methodology:
  • Hierarchical condition category (HCC) coding and documentation guidance
    • HCC models
      • CMS HCCs
      • HHS HCCs
  • Need for documentation
  • Risk adjustment data validation (RADV) audits
  • Key components of coding and auditing HCCs
  • Inpatient prospective payment system updates (IPPS)
  • Coding updates on IPPS final rule impacting HCCs
  • ICD-10-CM official guidelines for coding and reporting FY 2017
  • The best practices on a compliant query process for HCCs

Who Should Attend

  • Hospital Coding Staff
  • Clinical Documentation Improvement Management and Staff
  • Reimbursement Specialists
  • Coding Auditors and Educators
  • HIM Coding Supervisors, Managers and Directors

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About Our Speaker

Victoria M. Hernandez - AHIMA-Approved Trainer

Victoria M. Hernandez is an RHIA (Registered Health Information Administrator), a Clinical Documentation Improvement Practitioner (CDIP), Certified Coding Specialist (CCS), Certified Coding Specialist Physìcian-Based (CCS-P), an AHIMA-Approved ICD-10-CM/PCS Trainer and AHIMA CDIP Exam Item Writer with over 21 years of experience in the healthcare field. She is the founder of an auditing, coding and CDI company called Integrity Coding Solutions. Prior to starting her company, she was the...   More Info
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