What is Certified Risk Adjustment Coding?

Certified Risk Adjustment Coding involves coding diagnoses that affect risk adjustment models, which are used to predict healthcare costs and resource utilization.

Why is risk adjustment coding important?

Accurate risk adjustment coding ensures appropriate funding and resource allocation based on patient health status, impacting the quality of care and financial stability of healthcare organizations.

Hierarchical Condition Categories (HCCs) are a classification system used to group diagnoses that have similar cost patterns, essential for risk adjustment models.

What is Medical Coding in simple words?

Medical Coding can be put simply as the process of translating medical terminologies and treatment into codes. It is basically picking appropriate codes for various diagnosis and procedures done during a treatment or hospital stay.

Can you describe ICD?

ICD is the International Classification of Disease. It is created and maintained by the World Health Organization (WHO) for classifying injuries, deaths, and diseases since early 1900’s. ICD -10 is the 10th revision of the ICD and is currently in use in more than 80 countries. Every country using ICD can make modification to suit their requirement. United States uses ICD-10-CM (Clinical Modification)

Certified Risk Adjustment Coding Course

Module 1: Introduction to Risk Adjustment
- Overview of risk adjustment models (e.g., HCC, CDPS)
- Importance and impact of risk adjustment in healthcare
- Coding Guidelines
- ICD-10-CM coding guidelines
- Hierarchical Condition Categories (HCCs)
- Documentation requirements and best practices
Module 2: Pharmacology
- Understanding Mental Health Conditions
- Psychotropic Medications
- Coding for Mental Health Condition
Module 3: Risk Adjustment Models
- Hierarchical Condition Categories (HCC)
- Medicaid Chronic Illness and Disability Payment System (CDPS)
- Hybrid models
Module 4: Predictive Modeling & Quality of Care
- Predictive modeling impact
- Suspect logic
- Quality of care
- Star ratings
Module 5: Risk Adjustment and Financial Matters
- HCC RAF score
- Financial impact based on coding
Module 6: ICD-10-CM Coding Guidelines
- Demonstrate the ability to apply coding clinic guidelines to coding scenarios
- Demonstrate the ability to correctly code amputations
- Demonstrate the ability to correctly code artificial openings
- Demonstrate the ability to correctly code atherosclerosis
- Demonstrate ability to correctly code AV fistulas
- Demonstrate the ability to correctly code CHF
- Demonstrate ability to correctly code CKD
- Demonstrate the ability to correctly code device complications
- Demonstrate ability to correctly code COPD
- Demonstrate ability to correctly code CVA / Stroke
- Demonstrate the ability to correctly code dementia
- Demonstrate the ability to correctly code depression
- Demonstrate ability to correctly code DVT
- Demonstrate the ability to correctly code high blood pressure
- Demonstrate the ability to correctly code malnutrition
- Demonstrate the ability to correctly code manifestations of disease (e.g., DM, stroke, COPD).
- Demonstrate the ability to correctly code mental disorders
- Demonstrate the ability to correctly code neoplasms
- Demonstrate the ability to correctly code pneumonia
- Demonstrate the ability to correctly code pressure sores
- Demonstrate the ability to correctly code pulmonary embolism
- Demonstrate the ability to correctly code pulmonary fibrosis
- Demonstrate the ability to code seizures correctly
- Demonstrate the ability to correctly code skin ulcers
- Identify common coding errors in risk adjustment
- Identify diagnostic trouble codes that adjust the risk
- OBGYN-specific conditions that adapt to the risk
- Specific pediatric conditions that adapt to the risk
Module 7: Diagnosis Documentation and Coding
- Common errors in diagnosis coding
- Elements of the medical record
Module 8: Documentation Barriers
- Signatures
- Insufficient documentation
- Risk Adjustment Data Validation (RADV) process
- Official diagnosis coding guidelines
Module 9: Frequently coded conditions
- Acute vs. Chronic conditions
- Differential Diagnosis
- Risk Factors and Comorbidities
- Angina
- Artificial Openings
- BMI and Obesity
- Cardiac Conduction Disorders
- Cardiomyopathy
- CVA
- CKD, Dialysis, and AV Fistula
- OPD
- Complications of Care
- Congestive Heart Failure
- Cor Pulmonale
- DVT
- Dementia
- Depression
- Diabetes and Secondary Diabetes
- Epilepsy & Convulsions
- GERD
- Hepatitis & Cirrhosis
- HIV
- Hypercholesterolemia
- Hypertension
- Hypothyroidism
- Klebsiella Pneumoniae
- Malnutrition & Cachexia
- Myocardial Infraction
- Neoplasms
- Neuropathy
- Pneumonia
- Pulmonary Embolism
- Pulmonary Hypertension
- Respirator/Ventilator Status
- Septicemia & Sepsis
- Ulcers & Wounds
- Varicose Veins
- Vertebral Fractures
Module 10: Practical Expertise
- Practical diagnosis coding skills utilizing cases for practical application