What’s New in Risk Adjustment Payment Model: CMS Latest Updates

Course Description:

In this session, we will explore the intricacies of the risk adjustment payment model. By the end, you’ll have a comprehensive understanding of how this model works and how it differs from other payment models. We’ll explore the key components of risk adjustment, including definitions and terminology – clarifying concepts, scoring and mapping – how diagnoses equate to scores, and payment models – V24 versus V28. We will also provide an in-depth analysis of how risk adjustment factors and scores are calculated, using real-world examples to illustrate how the model captures severity of illness. Finally, we will apply what we have learned to actual case studies.

Learning Objectives:

Defining risk adjustment payment Models
Understand the CMS new guidelines for HCCs
Capture an accurate picture of patients’ health status
Learn how to calculate correct RAFs
Know how to measure severity of illness from the index
Guidelines for achieving a Compliant queries
Know how to get prepared for the Audit
Review and lesson learning from the recent examples

Areas Covered in the Session:

Traditional Medicare Versus Medicare Advantage
Risk Adjustment Defined
Hierarchical Condition Categories – Mapping, Trump List
Lines of Business – MCR, MCD, RxHCC, PACE, ACA
Components of a RAF Score
RAF Score Examples
Severity of Illness Explained
Blended Models V24 and V28
DSP, MEAT, TAMPER, CHEDDAR
Query
Audit
Examples
Live Q&A Session

Suggested Attendees:

Healthcare CEOs, CFOs, COOs
Healthcare Providers
Medical Coders
Medical Auditors
Medical Instructors
Primary Care Providers
Health Information Managers
Health Information Staff
CDI Specialist
A/R Staff
Supervisors and Managers
Revenue Cycle Employees and Managers

About the Presenter:

Tammy Allen, CPC, CRC, CPMA, CHONC, CDEO, has over 20 years of experience in the business of healthcare with significant exposure managing A/R for a number of recognizable facilities nationwide. She has served as an insurance reimbursement specialist and project manager for interventional radiology and cardiology coding audits, and medical coding and billing instructor. One of Allen’s passions is participating in the mentorship program to help newer coders find their way. She currently serves as a Risk Adjustment Auditor with over 10 years of experience coding and auditing HCCs for all lines of business for complete validation of the patient’s clinical profile.

Additional Information:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

Snippet From Our Previous Session:

Related Webinars You May Like:

Testimonials:

"This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course"

Melissa Preston, Health Information Management Staff

"David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN"

Sandie Fowler, Out of Network Billing Staff

"Great presentation. Able to do during the day. Timing was great"

Tina Duffy, Compliance Officer

Buy this