Are your coders accurately capturing chronic health conditions? Like disease registries, payers can use data mining to help identify gaps in documentation and diagnosis capture. Risk Adjustment Documentation and Coding Boot Camp Online Online Boot Camp Staff Shannon E. How long will the online content remain accessible after class ends? Centers for Medicare and Medicaid Services. This online course is designed for students to progress on a self-paced basis. This data set can be used to research disease prevalence by demographic elements. Risk Adjustment Coding a Joint Effort Risk adjustment coding requires health plan management, provider group management, physicians, non-physician providers, and highly skilled coding professionals to work together to capture the health status of their patient membership.
Analyzing the disease registry data can help identify under- and over-coding areas. Demographic variables Models include five demographic factors: age, sex, disabled status, original reason for entitlement, Medicaid or low-income status. References Centers for Medicare and Medicaid Services. This data can then be compared with diagnosis codes in the claims data. To cite a simple example, an individual with diabetes will have a higher risk score his or her predicted healthcare costs will be greater than an otherwise statistically identical individual without diabetes.
Who typically attends this Boot Camp? This course will review correct coding for common diagnoses that can impact your risk scores. This Boot Camp goes beyond just knowing how to code for a condition. This information is used to predict costs in the following year. This population represents more than 20% of those insured in the United States. However, continuous review of the health record documentation throughout the year is necessary to ensure all conditions have been considered and abstracted by the end of the year. Specificity of the clinical documentation is critical because risk adjustment coding professionals must be able to determine if a condition is current and active. Although the models are similar in purpose and structure, they each have unique characteristics to address the different patient populations for which they are utilized.
A best practice in all organizations—both payers and providers—is to promote thorough diagnosis coding for every encounter. High quality data and coding accuracy promote compliance. As such, incorrect or non-specific diagnoses can affect not only patient care and outcomes, but also reimbursement for that care, going forward. Cancellation Policy Please to view our cancellation policy. Risk Adjustment Coding a Joint Effort Risk adjustment coding requires health plan management, provider group management, physicians, non-physician providers, and highly skilled coding professionals to work together to capture the health status of their patient membership. Disease interactions result in higher risk scores when the disease pairs are present. To view our cancellation policy,.
Her experience also includes specialization as a compliance officer. Another approach to examine reporting patterns is using claims data to identify anomalies. The Risk Adjustment Documentation and Coding 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. Section tests require the student to achieve a grade of at least 80 percent in order to proceed to the next section. Since that time, she has worked at a variety of organizations, including academic, large, and small community hospitals.
Healthcare plans and healthcare facilities utilize the models. Furthermore, the collection of a specimen by a pathologist meets the face-to-face requirement, whereas a radiologist reading an imaging study is not considered a face-to-face encounter. Prospective model Uses diagnostic information from a base year to predict costs for the following year. The second approach is to select a targeted random sample. The curriculum trains medical coders in how to code and audit charts for risk adjustment. Furthermore, the collection of a specimen by a pathologist meets the face-to-face requirement, whereas a radiologist reading an imaging study is not considered a face-to-face encounter.
Risk adjustment aims to make comprehensive insurance available to all individuals, regardless of risk, and to allow plans that insure sicker-than-average populations to charge similar average premiums as plans that insure relatively healthy populations. Centers for Medicare and Medicaid Services. Under risk adjustment, an insurer who enrolls a greater-than-average number of high-risk individuals receives compensation to make up for extra costs associated with those enrollees. Historically, we have not shared contact information with anyone outside of our company. For example, patients may be entered in a diabetes registry based on prescribed medications e.
How is the course taught? This course will assist in preparation related to exam objectives that focus on risk adjustment. Does the course require any previous experience or training? Using rheumatoid arthritis as an example, medication data can be used to identify patients with active prescriptions for methotrexate. For example, there is a hierarchy for diabetes see Table 3. This is the full, unabridged version of this Practice Brief. This guide outlines everything from methodology to risk score verification. Similarly, it would be unusual for a patient to have multiple strokes in a brief period.
Organizations employ different strategies for reviewing clinical documentation. The balance is essential to ensure overall coding compliance. The complexities of risk adjustment coding and documentation can be daunting for health plans and providers. Repeated use of diagnoses is not penalized Providers should not be penalized for recording additional diagnoses. Example: Cardiomyopathy due to amyloidosis. Contact our sales team at 615-724-7200 or email. What material does the course cover? The purpose of the chart review is to determine if there is a gap in either coding, clinical documentation, or patient care that should be addressed.