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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? 

 

REGISTER YOUR TEAM TODAY!

 

ERM Consulting Inc.

https://www.ermconsultinginc.com/

Kameron Gifford, CEO ERM Consulting Inc.

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Kameron Gifford
CEO, ERM Consulting Inc.
ERM Consulting Inc

Kameron is the founder and Chief Executive Officer of ERM Consulting and mHealthGames, an online learning company. Kameron is passionate about risk adjustment and a strong physician advocate. Over the last 17 years she has worked hand in hand with medical practices, managed care organizations, hospitals and health plans to develop efficient billing practices, implement value added processes and improve the entire experience of care for their patients. Kameron is also a primary author of the following national risk adjustment workshops presented by RISE and Healthcare Education Associates: Risk Adjustment 101, HCC Coding Accuracy and Co-author of the new RISE Workshop: Advanced HCC Coding

www.ermconsultinginc.com

About Kameron

CEO, ERM Consulting Inc.
ERM Consulting Inc
Todd Gifford
Managing Director, ERM Consulting Inc.
ERM Consulting, Inc.

Prior to joining ERM Consulting, Todd was the Director of Finance for a large Medicare Advantage MSO based in Miami, Florida. He joined them in 2007 as Managing Director of Health Solutions UK, a joint venture with Humana. During his two and a half years in London he worked hand in hand with the NHS to transform the way care was delivered. From 2010 to 2012, Todd oversaw the start-up expansion into Texas. In this role, he was responsible for 12,500 MA members and a budget of $75m. Todd graduated from the University of Arkansas with a B.A. in 1991, and received his MBA from Webster University in 2001. He was awarded a Ph.D in Business from Woodfield University in 2013.

www.ermconsultinginc.com

About Todd

Managing Director, ERM Consulting Inc.
ERM Consulting, Inc.