Obtain Compliance with HCC Coding and Auditing

Why Should You Attend:

You should attend to learn the steps to improve and obtain ICD-10-CM coding and HCC valid reimbursement. Understanding the different HCC audit approaches to take can improve and enhance revenue and compliance.

Increased MA health plan scrutiny continues. The OIG has reported documentation and coding errors with several health plan audits.

Do you have all your HCC audits planned and/or being conducted in order to prevent risks? Healthcare fraud and abuse is on the radar of regulators. Are you prepared for CMS RADV? Millions of MA dollars could be at risk!

Risk Adjustment and HCCs can be confusing, how do the over 9700 ICD-10-CM codes map to one or more of the 86 HCCs within the version 24, CMS HCC Risk adjustment model. Auditing HCCs means documentation and Coding.

The ICD-10-CM codes that map to HCCs, are ultimately what drives risk adjustment factor (RAF) scores and per member per month (PMPM) premiums paid to a Medicare Advantage plan. Coding accuracy can be helped by knowing the most common HCCs and ICD-10-CM codes that are problematic. Understanding what documentation specificity is needed in order to capture the correct ICD-10-CM code and HCC is vital for auditing or healthcare practices, hospitals, and organizations.

There is greater OIG scrutiny with Risk Adjustment and the correct HCCs so there an imperative to always strive for HCC compliance and utilize audits. MA health plans are primarily reimbursed based on beneficiaries’ chronic conditions, these chronic conditions can be under documented and thus under coded, resulting in less reimbursement than the health plan actually received.

ICD-10-CM codes that equate to HCCs are an essential part of the HIM Coding and CDI professional’s foundational knowledge

• Learn about the compliance risks and how HCC Auditing can assist with improvements an enhance best practices
• Review the Medicare Advantage Risk Adjustment HCC requirements and many high-risk ICD-10-CM codes;
• Enhance knowledge of OIG reports and regulatory scrutiny.
• Identify risks, gaps and vulnerabilities with clinical documentation and ICD-10-CM coding.
• Improve accuracy, data integrity and compliance with HCC Auditing practices and RADV results.
• Understand, OIG MA Risk Adjustment audit findings.
• Learn how to improve documentation and coding accuracy for HCCs.

• Coding Supervisor/Manager – Outpatient and Inpatient
• Outpatient Coding Auditor
• Outpatient Coding Educator
• HCC coding staff
• Risk Adjustment Specialists
• Coder/Coding Professional (outpatient setting)
• Clinical Documentation Improvement (CDI) Specialist
• Coding Compliance Specialist/Mgr.
• Hospital ER and Inpatient coding professional
• Compliance Director
• Physician Office Coding Staff
• Revenue Cycle Mgrs.

Gloryanne Bryant
Independent Consultant, Self-Employed

Gloryanne is an HIM Coding professional and Leader for over 40 years. She has an RHIA (Registered Health Information Administrator), a Clinical Documentation Improvement Practitioner (CDIP), a Certified Coding Specialist (CCS), and a Certified Clinical Documentation Specialist (CCDS). Gloryanne is also an AAPC (American Academy of Professional Coders) member.

Currently she is an independent coding compliance consultant where she advises, guides and educates healthcare organizations, practices and professionals on clinical documentation improvement and compliant clinical coded data.

Ms. Bryant has conducted numerous educational programs on ICD-10-CM/PCS and CPT coding.

Ms. Bryant continues to advocate for compliant clinical documentation and data quality; and is passionate about helping healthcare have accurate and reliable coded data.

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