Risk Adjustment/Coding Toolkit

NOTE: You must login to your Alliance account to access the articles and resources below. Some content may only be accessible to Alliance members.

 

4/15/2021

Pre-Work Packet: Coding Work Group 2021, Session 2: Paramount Health Care
The Paramount Health Care team reviews a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

4/5/2021

Recording: To Code or Not to Code?
As part of the Risk Adjustment & Quality Learning Collaborative, Centauri Health Solutions leads a review of the official guidelines for coding and reporting. Best practices for appropriate diagnosis code capture and then practice applying the guidelines to documentation examples are covered.

4/1/2021

Recording: Coding Work Group 2021: Session 1 - Providence Health Plan
Collaborate with your Alliance peers on risk adjustment coding best practices. Review of five to six guidelines that give coders trouble (like coding BMI/obesity as an example) and invite participants to ask questions and share their best practices are covered.

4/1/2021

Presentation: To Code or Not to Code?
As part of the Risk Adjustment & Quality Learning Collaborative, Centauri Health Solutions leads a review of the official guidelines for coding and reporting. Best practices for appropriate diagnosis code capture and then practice applying the guidelines to documentation examples are covered.

3/30/2021

Presentation: The Risk Adjustment Jacobian and Natural Language Processing
Tessellate discusses the risk adjustment jacobian, NLP, and compliance guidelines.

3/30/2021

Medicare Benefit Policy Manual Chapter 10-Ambulance Services
Paramount Health Care provides Alliance members with the policy to follow for Medicare Benefit Policy Manual Chapter 10- Ambulance Services, to pay for covered ambulance procedures used for emergency transportation as reported by the provider of service.

3/22/2021

Discussion Packet: Coding Work Group 2021: Session 1 - Providence Health Plan
Collaborate with your Alliance peers on risk adjustment coding best practices. During this session, we'll review five to six guidelines that give coders trouble (like coding BMI/obesity as an example) and invite participants to ask questions and share their best practices.

3/8/2021

Recording: All about Hormones: Correctly documenting and coding for Endocrine Disorders
This session is one in a series focused on delivering educational risk adjustment coding content. As part of the Risk Adjustment & Quality Learning Collaborative, Diane Escandell will focus on assisting coders in making appropriate decisions when it comes to coding particularly challenging documentation, provide updates on new diagnostic codes and HCC model updates, or discuss documentation that was accepted or not accepted by CMS.

3/4/2021

Presentation: All about Hormones: Correctly documenting and coding for Endocrine Disorders
This session is one in a series focused on delivering educational risk adjustment coding content. As part of the Risk Adjustment & Quality Learning Collaborative, Diane Escandell will focus on assisting coders in making appropriate decisions when it comes to coding particularly challenging documentation, provide updates on new diagnostic codes and HCC model updates, or discuss documentation that was accepted or not accepted by CMS.

2/28/2021

Recording: Doubling Down: Dual HHS-RADV Audits
This year, we’ll be managing dual RADV audits. As part of the Risk Adjustment & Quality Learning Collaborative, Centauri Health Solutions reviews the HHS-RADV activities calendar, the challenges, and best practices for managing different coding rules by benefit year.

2/25/2021

Presentation: Doubling Down: Dual HHS-RADV Audits
As part of the Risk Adjustment & Quality Learning Collaborative, Centauri Health Solutions reviews the HHS-RADV activities calendar, the challenges, and best practices for managing different coding rules by benefit year.

2/20/2021

Recording: A sense of urgency: Recognizing the importance of precise coding for acute conditions
As part of the Risk Adjustment & Quality Learning Collaborative, Pulse8 leads a discussion focused on delivering educational risk adjustment coding content. The topic of this session hasn’t been set yet, but will focus on assisting coders in making appropriate decisions when it comes to coding particularly challenging documentation, provide updates on new diagnostic codes and HCC model updates, or discuss documentation that was accepted or not accepted by CMS.

2/18/2021

Presentation: A sense of urgency: Recognizing the importance of precise coding for acute conditions
As part of the Risk Adjustment & Quality Learning Collaborative, Pulse8 leads a discussion focused on delivering educational risk adjustment coding content. The topic of this session hasnâ??t been set yet, but will focus on assisting coders in making appropriate decisions when it comes to coding particularly challenging documentation, provide updates on new diagnostic codes and HCC model updates, or discuss documentation that was accepted or not accepted by CMS.

2/12/2021

Recording: Health New England Case Study: Improving care follow up and health outcomes through performance improvement projects_- February 10, Session 2
Health New England shares how they improve care follow up and health outcomes through performance improvement projects at the RA & Quality Micro Summit - February 10, Session 2.

2/12/2021

Recording: ESRD: New challenges and solutions_Change Healthcare - February 9, Session 2
Change Healthcare discusses enrolling new member with ESRD, paperwork strategies to ensure revenue is right, home and facility dialysis, and retroactive payments including the completion of CMS-2728 form. Shared at the RA & Quality Micro Summit - February 9, Session 2.

2/12/2021

Recording: Building a best in class outpatient Coding and Documentation Improvement (CDI) program for providers
As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty discusses best practices in engaging providers around coding and documentation improvement.

2/11/2021

Presentation: Building a best in class outpatient Coding and Documentation Improvement (CDI) program for providers
As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty discusses best practices in engaging providers around coding and documentation improvement.

2/10/2021

Recording: How CDPHP is using Natural Language Processing to enhance risk adjustment and quality outcomes
The CDPHP team details its Natural Language Processing (NLP) structure and overview. Shared at the Risk Adjustment and Quality Micro Summit 2021.

2/10/2021

Reference Material: CROWN collection method mandated by CMS for ESRD
Sentara shares this file as a reference document as part of their workflow: Consolidated Renal Operations in a Web-enabled Network (CROWN) is a Web-based data-collection system mandated by CMS to enable dialysis facilities to meet portions of the Conditions for Coverage for End Stage Renal Disease (ESRD) Dialysis Facilities. Discussed at RA & Quality Micro Summit during ESRD: New challenges and solutions session - February 9, Session 2.

2/10/2021

Reference Material: ESRD Workflow_Sentara
Kami Andrews developed the workflow and is Sentara's ESRD contact. Sentara Health Plans shares their ESRD workflow during ESRD session at RA & Quality Micro Summit at ESRD - February 9, Session 2.