Risk Adjustment/HCC Coder/Auditor Training

HCCTRAIN
Online Education Courses
40

AHIMA has partnered with MARSI to present the first Risk Adjustment Coding/Auditing course that prepares professionals for risk adjustment coding while going a step further to address chart auditing. This course presents extensive, in depth education for those working in risk adjustment that need a thorough understanding of HCC’s, coding, and auditing. Coders also gain the tools and skills required to audit when just looking at patients’ charts, understanding the coding guidelines isn’t enough. Coders must recognize how documentation issues affect both the revenue opportunities and the compliance concerns. This course presents a methodology for coders to audit charts, logically categorize findings, and create a method for helping ensure findings are appropriately addressed.

The curriculum trains medical coders in how to code and audit charts for risk adjustment. Specifically, the course addresses Hierarchical Condition Categories coding using the vast and complex array of CMS guidelines (MA-HCC). Prerequisites for this course are Anatomy, Physiology, and Medical Terminology. An operational understanding of ICD-10-CM is helpful.

The course requires approximately 40 to 60 hours of study, and has five main sections with study modules and quizzes within each section. Section tests require the student to achieve a grade of at least 80 percent in order to proceed to the next section. After completing all five sections, there is a comprehensive final exam.

This online course is designed for students to progress on a self-paced basis. The curriculum includes additional training materials such as study guides and worksheets. All quizzes and tests are included, including the final exam at no additional cost.

Students completing the course will understand:

  • What risk adjustment means and how it works for Medicare Advantage
  • Documentation and coding guidelines that apply to Hierarchical Condition Categories (HCCs)
  • Specific coding guidelines applicable to Infectious and Parasitic Diseases, Neoplasms, Diseases of the Blood and Blood-Forming Organs, Diabetes, Endocrine, Nutritional and Metabolic    Diseases, Mental/Behavioral, Alcohol and Drug, Nervous System), Diseases of the Circulatory System, Pulmonary, GI Disorders, Skin and Subcutaneous Tissue, Musculoskeletal System, Genitourinary Disorders, Congenital Anomalies, Symptoms Signs and Ill Defined Conditions, Injury and Poisoning, External Causes of Morbidity, Z Codes
  • Auditing concepts, how to apply them and how to work with suspects and queries when auditing charts

Objectives:

  • Develop a thorough understanding of ICD-10-CM guidelines including Coding Clinic and CMS 2008 Participant Guide
  • Understand how to apply guidelines to medical chart documentation
  • Develop familiarity with diseases by ICD-10-CM Section and by HCC, and identify which diseases risk adjustment
  • Understand how CMS hierarchy applies to payment
  • Learn to identify insufficient or incomplete documentation and the impact on HCCs
  • Be able to explain the best practice use of queries and how to formulate those queries

$1,995.00

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