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.

 

2/9/2021

Presentation: Clinical integration challenges during the pandemic - February 9, Session 1
The Network Health team shares its clinical integration challenges and how they've been working to solve them - all while navigating a global pandemic! Shared at the Risk Adjustment & Quality Micro Summit 2021.

2/9/2021

Recording: Should We Claim It?
As risk adjustment coders, we often ask ourselves, “Should we claim it?” As part of the Risk Adjustment & Quality Learning Collaborative, Monica Watson reviews common claims billing errors in the provider setting that impact risk adjustment / HCC submissions, best practices for identifying deletes, and more.

2/9/2021

Presentation: ESRD: New challenges and solutions_Change Healthcare - February 9, Session 2
Change Healthcare discusses enrolling new members 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.

2/9/2021

Recording: Clinical integration challenges during the pandemic
The Network Health team shares its clinical integration challenges and how they’ve been working to solve them – all while navigating a global pandemic. Shared at the Risk Adjustment and Quality Micro Summit 2021.

2/4/2021

Presentation: Should We Claim It?
As risk adjustment coders, we often ask ourselves, â??Should we claim it?â? As part of the Risk Adjustment & Quality Learning Collaborative, Monica Watson reviews common claims billing errors in the provider setting that impact risk adjustment / HCC submissions, best practices for identifying deletes, and more.

2/1/2021

Recording: Risk Adjustment Comparative Overview
As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty provides a comparative look at the different risk adjustment models in the Medicare Advantage, ACA, and Medicaid space.

1/29/2021

Agenda: Risk Adjustment & Quality Micro Summit 2021
As part of the Risk Adjustment & Quality Learning Collaborative, Alliance members dig into real-life examples of how they are meeting clinical integration and risk adjustment challenges during the pandemic and share plans for strategic initiatives poised to launch in a post-COVID world.

1/28/2021

Presentation: Risk Adjustment Comparative Overview
As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty provides a comparative look at the different risk adjustment models in the Medicare Advantage, ACA, and Medicaid space.

1/26/2021

Recording: Documentation and Coding: Best Practices for Chronic Conditions
CMS has instructed that only ‘active’ conditions should be reported via a claim for risk adjustment. As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty with Gorman Health Group discusses what documentation elements are required to substantiate a chronic diagnosis through a Risk Adjustment Data Validation audit.

1/26/2021

Presentation: Documentation and Coding: Best Practices for Chronic Conditions
CMS has instructed that only active conditions should be reported via a claim for risk adjustment. As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty with Gorman Health Group discusses what documentation elements are required to substantiate a chronic diagnosis through a Risk Adjustment Data Validation audit.

1/26/2021

Recording: Navigating Risk-Adjustable Chronic Conditions: The Ultimate Course for the PCP
This session is one in a series 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.

1/26/2021

Presentation: Navigating Risk-Adjustable Chronic Conditions: The Ultimate Course for the PCP
This session is one in a series 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.

1/26/2021

Acceptable Physician Specialty Types for 2020 PY
CMS provides a comprehensive list of specialists that are approved for risk adjustment for 2020.

12/16/2020

Recording: Natural Language Processing: Impact on Coding_Change Healthcare
Change Healthcare explains the impact of the Natural Language Processing (NLP) on code operations, such as code assignment, process, productivity, compliance and financial impact.

12/9/2020

Presentation: Natural Language Processing_Change Healthcare
Change Healthcare explains the impact of the Natural Language Processing (NLP) on code operations, such as code assignment, process, productivity, compliance and financial impact.

11/19/2020

Recording: Coding Work Group Session 6: MediGold
Collaborate with your Alliance peers on risk adjustment coding best practices. During each session, you'll review 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.

11/19/2020

Chat Transcript: Coding Work Group 2020, Session 6: MediGold
Collaborate with your Alliance peers on risk adjustment coding best practices. During each session, you'll review 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. Remaining time is used for open discussion.

11/19/2020

Presentation: The New Medicare HCC Model V24 (Earn 1 CEU)
As part of the Risk Adjustment & Quality Learning Collaborative, Change Healthcare discusses the new HCC model, version 24, as updated by CMS.

11/19/2020

Recording: The New Medicare HCC Model V24 (Earn 1 CEU)
As part of the Risk Adjustment & Quality Learning Collaborative, Change Healthcare discusses the new HCC model, version 24, as updated by CMS.

11/3/2020

Recording: Risk Adjustment Round Table 2020, Session 6: Using AWS for Edge Server Submissions
Wesley Sanders, Vice President, Finance and Analytics at Alliant Health Plans shares step-by-step instructions, best practices, and detials on his experience working with the CMS EDGE support team while moving your Edge Server submissions in-house.