Risk Adjustment/HCC Coder/Auditor Course
ICD‐10: CM - Course Outline
Section 1 Welcome to the World of HCC Module 1:
• Medicare Advantage and HCC • What is HCC • Specifics of HCC coding and Documentation – New Model Changes PY 2015 • Coding for HCC • Quiz Section Test
Sec/MARSI_HCC_RA_Coder_Auditor_Course_Outline.pdftion 2 Documentation and Auditing Guidelines for HCC Module 1: • Documentation Requirements • General Coding Guidelines • Quiz Module 2: • Coding Guidelines by Category HCC 1‐55 • Quiz Module 3: • Coding Guidelines by Category HCC 67‐176 • Quiz Section Test
Section 3 Coding Guidelines and Conditions by Chapter Module 1: • Part 1 & Part 2‐ Specifics of HCC Coding & Specifics by Chapter 1‐4 • Quiz Module 2: • Specifics by Chapter 5‐8 • Quiz Module 3: • Specifics by Chapter 9‐13 • Quiz Section Test
Section 4 Concepts behind the Spreadsheet – 18 Slides Module 1: • Review of the Basics • Quiz Module 2: • Understanding the Auditing Guidelines • Quiz
Module 3:
• The Categories Described Section Test
Section 5 Suspects & the Query Process Module 1:
• Suspects & Queries • Quiz Module 2: • Cardio, Vascular, Ulcers • Quiz Module 3: • Neuro, DM, Eye, Kidney • Quiz Module 4: • GI, Liver, Dependence, Depression Injuries & Poisonings • Quiz Module 5: • Neoplasm's, Hematology, Infections, Malnutrition, Pulmonary • Quiz Module 6: • Bone, Joint, Muscle Infections, Inflammatory, Fractures, Complications, Suspects • Quiz Section Test
Final Exam
Learning Objectives:
1. Develop a thorough understanding of ICD‐10‐CM guidelines including Coding Clinic and CMS 2008 Participant Guide 2. Understand how to apply guidelines to medical chart documentation 3. Develop familiarity with diseases by ICD‐10 –CM Section and by HCC, and be able to identify which diseases risk adjust. 4. Understand how CMS hierarchy applies to payment. 5. Learn to identify insufficient or incomplete documentation and the impact on HCCs 6. Be able to explain the best practice use of queries and how to formulate those queries.