PPT-CMS-Hierarchical Condition Codes and Risk Adjustment

Alice B Torrez MHA CPC Educator Coding and Documentation Health Information Management University of New Mexico Hospital 2 View of Risk Adjustment Are my patients sicker These numbers are not right. Colorado Division of Insurance. Risk Adjustment Question. Who should administer Risk Adjustment in Colorado?. Federal Government; or. State Government:. Use Federal Model (2012 Exchange Bill says to “strongly consider”). Socioeconomic Status;. Linking Cost and Quality Measures. HSCRC . Performance Measurement . Workgroup. May 28, 2014 . Tom Valuck, MD, JD. Presentation. . Overview. U. pdate . the . Performance Measurement Workgroup . Socioeconomic Status;. Linking Cost and Quality Measures. HSCRC . Performance Measurement . Workgroup. May 28, 2014 . Tom Valuck, MD, JD. Presentation. . Overview. U. pdate . the . Performance Measurement Workgroup . A Work Plan for State Officials. December 2, 2011. Ross Winkelman, FSA Mary Hegemann, FSA and Syed Mehmud, ASA. Contributions by Tom Leonard, James Woolman, Julie . Peper. , and Patrick Holland. Caveats. An Introduction and Discussion. MAPAM. March 16, 2017. Agenda. Risk Adjustment . How Risk Adjustment Works. Risk Adjustment Factor (RAF) Scoring Process. Comprehensive Annual Visits. Predictive Modeling & Quality of Care. (HCC Coding). Payment Model. General. Education Guide. 1. What is CMS’s . Hierarchical Condition Categories. ?. Medicare Risk Adjustment. payment model introduced by the Centers for Medicare and Medicaid (CMS) in 2004.. Association of Clinical Documentation Improvement Specialists. Indiana Chapter. Indianapolis, IN. April 21, 2018. What are HCCs?. Risk adjustment system based on diagnosis codes. HHS-HCCs. ACA plans. Risk adjustment. Program establish by Centers for Medicare and Medicaid Services [CMS]. GOAL. : to allocate resources to those patients who most need them, based on each patient’s severity of illness. Error Correction for Risk Adjustment Submissions Workshop: Preparing for Sweeps August 1, 2019 Transforming Risk Adjustment Through Insight, Transparency and Control Welcome Lisa Pouncey Senior Director of Product Management 33-225 6/18bcbskscomCurrent Diagnosis Codes vs History Diagnosis CodesDiagnosis coding is the primary indicator for risk adjustment calculation and auditing Under a risk adjustment model present relev Does . your . plan’s strategy violate the False Claims Act?. Phillips & Cohen LLP. www.phillipsandcohen.com. 2. Overview of Risk Adjustment Fraud. Risk adjustment fraud is essentially “upcoding” for diagnosis codes. ICD-9-CM Coding,. 2015 . Edition. Chapter 1: . Characteristics . of . ICD-9-CM . and ICD-10-CM. Learning Objectives . Review the chapter’s learning objectives. A thorough understanding of the basic concepts of the ICD-9-CM and ICD-10-CM classification systems is critical in order to comprehend the more advanced theory to follow in the rest of the chapters.. 2016. Risk Adjustment and Hierarchical Condition Category (HCC) Coding . Mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997.  . Model assigns a risk factor score to individuals with serious or chronic illness based upon a combination of the individual’s health conditions (ICD-10) and demographic details.. Linking Cost and Quality Measures. HSCRC . Performance Measurement . Workgroup. May 28, 2014 . Tom Valuck, MD, JD. Presentation. . Overview. U. pdate . the . Performance Measurement Workgroup . on NQF .