Whether you are an experienced coder in risk adjustment or seeking better understanding, this course will take you through the fundamental principles underlying Medicare Risk Adjustment coding.

Risk adjustment is a component of the new health care reform law that is designed to improve coverage, preserve consumer choice and improve quality of care for patients. It currently applies to Medicare Advantage plans and Medicare prescription drug programs. The Patient Protection and Affordable Care Act has established a risk adjustment system for plans in the commercial individual and small group markets.

With the increase of Medicare Advantage plans and inclusion of risk adjustment models in the ACA, proficiency in selecting diagnosis codes and how it relates to risk adjustment models including Hierarchical Condition Categories (HCC), Chronic Illness and Disability Payment Systems (CDPS), and blended models is a valuable skill. There is a strong emphasis on the HCC model in this course because it is one of the most recognized.

• Define different models of risk adjustment (HCC, CDPS, Hybrid)
• Understand predictive modeling and its impact on risk adjustment
• Explain risk adjustment impact on financial matters
• Apply official coding guidelines
• Identify elements of the medical record
• Identify documentation deficiencies for diagnosis coding
• Understand the most common conditions in risk adjustment and how to properly
code in ICD-10-CM

Cost of the course includes textbook and ICD-10-CM coding manual. Course content can be completed at any speed within a 5-month access window. Additional months can be purchased for $30/month.

By purchasing this online course, I certify that I have read and agree to the online course Terms & Conditions.

Instructor: Simone F. Thomas, MHSc, MHL, CCS, CCS-P, CDIP, CHTS-TR, HCS-H, CRC, CPC, CPC-I

CEUs Awarded: 30 AAPC CEUs upon successful completion with an overall score of 70% or better

Access Syllabus

Cost: $395

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