SMG Risk Adjustment New Provider Training

The goal is to enhance knowledge to the principles of Value Based Hierarchical Condition Category(HCC) Risk Adjustment(RA) model(s) and the importance of accurate and complete documentation requirements for ICD-10-CM diagnosis coding. • Review Hierarchical Condition Category (HCC) Value Based Risk Adjustment model(s) and why it is important • Stronger understanding of the medical coding guidelines and regulations, including compliance and the impact of diagnosis coding • Mindfulness to the auditing process for Center for Medicare and Medicaid Services (CMS) - HCC risk adjustment models and documenting and reporting chronic conditions yearly • Awareness of “other” HCC Risk Models (Commercial, Medicaid (TENNCARE)) • Realize the importance of a Risk Adjustment auditing process For accurate HCC coding, providers need to capture the complete diagnostic profile of every patient, including all information that influences a patient’s evaluation, care, and treatment to ensure appropriate payment and risk-adjustment factor (RAF) score.