About the Course

Course Overview

  • Reference Materials, Worksheets and Study Guides
  • Section 1 – What is HCC
  • Section 2 – Documentation and Auditing Guidelines for HCC
  • Section 3 ‐ Coding Guidelines and Conditions by Chapter
  • Section 4 ‐ General Guidelines – Chart Notes – HCC Coding
  • Section 5 – Suspects and the Query Process
  • Final Exam

Advanced Coder/Auditor Training

  • Advanced

    The course does not simply present HCC coding rules but goes much further.

  • Coding

    Accurate coding of thorough documentation is essential to help ensure appropriate reimbursement for delivered services. Risk Adjustment and Hierarchical Condition Category (HCC) coding, a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997, is no exception. HCCs are used pervasively in value based reimbursement including risk adjusted methodologies such as Medicare Advantage, ACOs and the Affordable Care Act.

  • Documentation

    Since the majority of HCCs are assigned by physicians or their office staff who frequently have less formal training, supporting documentation and coding compliance must be audited. Similar to inpatient DRGs, HCC specialists must be able to read an entire chart and be able to develop unique queries to physicians in reference to their documentation. This course provides the unique training necessary to be successful in this role.

  • Success

    The five section course is broken into modules, which create natural places within the course to pause and return later. The learner must score at least 80% on each sectioned quiz before moving forward to the next section.

Learning Objectives

1

ICD-10-CM

Develop a thorough understanding of ICD‐10‐CM guidelines including Coding Clinic and CMS 2008 Participant Guide

2

Apply Guidelines

Understand how to apply guidelines to medical chart documentation.

3

Diseases that Risk Adjust

Develop familiarity with diseases by ICD‐10–CM Section and by HCC, and be able to identify which diseases risk adjust.

4

CMS Hierarchy

Understand how CMS hierarchy applies to payment.

5

Documentation Impact

Learn to identify insufficient or incomplete documentation and the impact on HCCs.

6

Formulate Queries

Be able to explain the best practice use of queries and how to formulate those queries.

The five section course is broken into modules, which create natural places within the course to pause and return later.

Career Skills for Life