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APPROVED by the AAPC for 5 CEUs
Course Overview
Medicare Advantage (MA) is one of the fastest-growing and most complex health plan lines of business representing significant growth opportunities for payers. Launching and/or managing a successful MA market requires careful, strategic planning to meet requirements, ensure compliance, and maximize the program benefits for your organization.
Success in this market will depend on success in each of the following essential areas:
Value-based contractingClinical documentation and codingDelivering high quality careManaging utilizationThis course will touch on all four essential areas of MRA Operations.
Learn more or Register here
Review the Agenda below:
Risk Adjustment Operations
Medicare Risk Adjustment OverviewHistory of Medicare Risk AdjustmentKey Concepts and TermsRisk Adjustment DataRisk Adjustment ProcessRisk Adjustment Data ValidationCMS-HCC Risk Models
PY 2020 CMS HCC Risk Adjustment ModelPY 2021 CMS HCC Risk Adjustment ModelPY 2022 CMS HCC Risk Adjustment ModelCalculating Risk Scores and Payments
General Payment RulesData Submissions and PaymentsPY 2020 Risk Score CalculationsPY 2020 CMS-HCC Payment Calculation ExamplePY 2021 Risk Score CalculationsPY 2021 CMS-HCC Payment Calculation ExampleOptimizing RA Operations
Network Adequacy GuidanceMedicare Star RatingsGrowth and RetentionReports and ResourcesVisit www.ERM365.org to see more courses.
For the 2020 performance year, MIPS eligible clinicians, groups, and virtual groups can submit an application to the Centers for Medicare and Medicaid Services (CMS) asking the agency to re-weight one or more performance categories to 0% due to the COVID-19 public health emergency. This means if you have concerns about the impact of the COVID-19 public health emergency on your performance data – including cost measures – you can submit an application to CMS and cite COVID-19 as the reason for your application.
CMS has recently announced that it will be extending the deadline for COVID-19-related 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception applications to February 1, 2021.
If you have concerns about the effect the COVID-19 public health emergency will have on your performance data for the 2020 performance period, including cost measures, submit an application now and make sure you cite COVID-19 as the reason for your application. The deadline to submit a MIPS Promoting Interoperability Performance Category Hardship Exception application or an Extreme and Uncontrollable Circumstances application not related to COVID-19 remained December 31, 2020. If you are already exempt from reporting Promoting Interoperability data, you don’t need to apply.
Once you have an approved application, you can still receive scores for the Quality, Improvement Activities and Promoting Interoperability performance categories if you submit data. If the Cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted. It is important to note that you cannot submit an application to override data for program year 2020 that has already been submitted and any data submitted either before or after an application has been approved will be scored.
MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline Extended to February 1, 2021 – Policy & Medicine
Let’s Talk About Risk On-Demand
Join us on-demand for this event recorded 11/11/2020. The presentation is an introduction to risk adjustment and HCC coding for coders, physicians and other healthcare professionals.
Approved by the AAPC for 2 CEUs - only $14.99
https://erm365.org/courses/lets-talk-about-risk-on-demand/
Review the Agenda:
Section 1 – Risk Adjustment Basics
This section will cover basic concepts and terminology in the CMS-HCC Model of Risk Adjustment.
What is an HCC?Why are HCCs important?How is a risk score calculated?What is the value of an HCC?What are the most common HCCs?Section 2 – Rules of the Road
This section will cover ICD-10 Guidelines and other “rules” related to clinical documentation and coding within the CMS-HCC Model of Risk Adjustment.
When should a diagnosis be coded?How often can a diagnosis be codedWhat clinical documentation is needed to support the diagnosis?Is it okay to code for resolved conditions?Would it be acceptable to code a diagnosis documented as “suspected” in an outpatient setting such as a provider’s office?Section 3 – HCC Coding
This section will review the most common HCC’s for Medicare enrollees based on MedPAC data.
What are the twenty most common HCC categories for Medicare enrollees?What are the most common ICD-10 codes included in each category?How can clinical documentation impact code selection?What are common errors leading to inaccurate risk scores?Section 4 – Tips for Success
This section will cover simple tips that will make a big impact. At the end of this lesson you will be able to work smarter not harder.
What should be included in the problem list?Why does clinical documentation need to clarify active vs. history of?What small changes can you start making today that will have a big impact on the accuracy of your risk scores?
Who Should Attend?
Coders, Billers, and AuditorsPhysicians, NPs and PAsMedical Assistants and Front Office Price: $14.99Purchase includes a copy of the presentation and other resources. 180 days of access to course and materials.
On Demand Course Instructions for CEUs:
Login or Register for a FREE account with ERM365.Purchase the course.Click on “My Dashboard” and then “My Courses” to access.Download the handouts and other resources.Watch the video.Pass the post quiz.Download CEU Certificate. Would you prefer to attend a LIVE event? Visit https://erm365.org/events/ to view the schedule and register.
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