Knowledge Library Risk Adjustment and HCCs
Thursday, June 22, 2017

Risk Adjustments and HCCs

HIM professionals now engage across the healthcare enterprise, including ambulatory, acute, and postacute settings, thanks to their necessary involvement in implementing CMS' risk adjustment and Hierarchical Condition Category (HCC) coding system.

Implemented by CMS in 2003 and the reimbursement basis for Medicare Advantage plans since 2004, the HCCs payment model predicts the annual cost of care for severe or chronically ill patients. With increased focus on healthcare cost containment, HCC coding continues to gain ground as the payment model under the ACA, and is the risk adjustment model mandated by CMS for Accountable Care Organizations (ACOs).

Don’t miss experienced coding educator, author and consultant Kathryn DeVault, MSL, RHIA, CCS, CCS-P, FAHIMA, as she reviews the definitions of risk adjustment factor (RAF) and HCCs, the importance of complete documentation in the outpatient setting, the impact of clinical documentation in risk adjustment and the impact of documentation related to HCC capture and assignment. She will also share an example HCC audit case study.

Kathy DeVault is currently a manager of HIM Consulting Services at UASI, where she leads engagements helping healthcare facilities achieve correct reimbursement in the quickest possible time. Before her current role, Ms. DeVault served as the Senior Director, HIM Practice Excellence for AHIMA, where she was one of the primary authors and instructors for the AHIMA ICD-10-CM/PCS Academies, as well as technical advisor on ICD-9-CM, ICD-10, and CPT coding publications. Prior to joining AHIMA, Ms. DeVault served as data quality analyst for coding in a regional healthcare system. She was also a coding educator, and has presented numerous seminars and educational sessions on coding and health information management (HIM)-related topics.

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