Improving the Quality of Patient Care through Hierarchical Condition Category (HCC) and Risk Adjustment Coding

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

MACRA Payment Methodologies, HCC Coding & Clinical Documentation Improvement With Case Scenarios

MACRA will change the current types of payment models and providers must understand and focus on the importance of clinical documentation, including how documentation and coding will be critical in capturing acuity, severity and chronic patient conditions.

Under the MACRA framework, healthcare providers who provide better quality of care will be rewarded. Collected data that is gathered under these requirements will impact provider reimbursement by 2019 and providers need to understand the impact, as well as how to better quantify and qualify patient data.

In this session, expert speaker Gail Ann Madison-Brown will discuss the current quality programs that will be combined and streamlined into the Medicare Accèss and CHIP Reauthorization Act (MACRA). She will discuss Hierarchical Condition Category (HCC) coding and provide examples of specific diagnosis codes related to HCCs to understand the impact of HCC diagnosis coding on a provider’s Risk Adjustment Factor (RAF). Gail will also provide tips on improving clinical documentation with examples to assist in improved and more specific coding of patient services.

Additionally, Gail will discuss the selection of HCC codes and frequency of review, as well as provide an overview of MACRA components and payment methodologies.

Session Highlights:

  • How MACRA will replace and streamline current healthcare quality programs
  • How MACRA relates to HCC coding
  • Importance of HCC coding to reimbursement under MACRA programs
  • Improved clinical documentation practices necessary to ensure and capture appropriate medical coding
  • How HCC codes relate to specific diagnosis codes and how to capture and report the codes
  • How HCC coding impacts your “RAF” Risk Adjustment Factor
  • The importance of capturing the acuity, severity and chronic conditions of your patient population
  • Recommendations for proper code selection, review of coding processes and capturing all active chronic conditions annually
  • Documentation jargon to avoid

Session Agenda:

  • MACRA basics
    • Quality Payment Program (QPP)
    • Merit-Based Incentive Payment System (MIPS)
    • Advanced Alternative Payment Models (APMs)
  • MIPS performance categories
  • Understanding risk adjustment factor and risk adjustment scores
  • HCC coding
    • CMS HCC model principles
    • Common HCC categories
    • General mapping principles
    • HCC principles
  • Coding comparison of RAF scores
  • HCC accumulation of unrelated diseases
  • Physician and coder roles
  • Clinical documentation improvement
  • Documentation basics
  • Pertinent conditions / chronic conditions
  • Documentation of ‘forever codes’
  • Case scenarios

Who should attend?

  • Coders
  • Providers (applies to all generalists, specialists and hospitalists)
  • Compliance and quality professionals

Order Below or Call 1-844-384-4744 Today

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About Our Speaker

Gail Ann Madison Brown


Gail Madison-Brown has extensive experience in healthcare compliance, revenue cycle, auditing and coding programs. She has over 25 years of experience as a Registered Nurse and many years as an attorney. She has spoken for professional healthcare organizations, as well as for state public health departments.

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