Webinar on Risk Adjustment and RADV Audits

A sneak peak of what’s in the presentation:

Ø  Information on CMS’s Hierarchical Condition Categories

Ø  HCC payment methodologies

Ø  Documentation best practices

Ø  Top 10 RADV red flags

Ø  RADV medical record checklist

Ø  Practice reminders

Ø  Top 10 documentation issues

HCC medical coding tips for practices

It’s Third Quarter of 2017 and the Medicare Advantage (MA), Plans are ramped up and ready to begin a third set of “HCC Sweeps”, for the year.  The beginning of each “sweep” period, by United, Humana, Freedom, Aetna and all the other players in the pond, should start with ensuring they have Certified Remote HCC (CRC – Certified Risk Adjustment Coders), coders in-house or remotely employed and this year, leave the novices at Risk Adjustment Coding, to train for the following year, instead of onboarding them now.  In light of recent DOJ developments.

The recent allegations by the Department of Justice (DOJ) are significant, the DOJ has made has alleged, based on audit results, that some MA Plans have been involved with upcoding of diagnoses codes that exaggerated the severity of illness of some members. This led to much higher weighted HCCs and in turn more money from CMS to the plan, for that member annually.  Please click on the following links for further information:
https://goo.gl/odsg8n