Let’s Talk About Risk 

Review the agenda below: 

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 coded?

- What 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? 

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