Upcoming V28 Risk Adjustment Webinars

Are you looking for the BEST V28 Risk Adjustment Education? If so, GREAT NEWS – you found it! Register today for the ALL NEW V28 Webinars. Tickets are $29.99 each – Bring the team and receive a 10% discount when you purchase 3 or more tickets for any event. All webinars are approved for 2 AAPC / AHIMA CEUs.

 

June 24, 2023, 2:00 PM to 4:00 PM – Introduction to V28 Risk Adjustment

Registration Link: https://events.eventzilla.net/e/introduction-to-v28-risk-adjustment-2138590700

Agenda:

• Discuss the NEW V28 CMS Risk Adjustment Model.
• Review Updated HCC Categories and Diagnoses.
• Key Steps to Take Now for Success in 2024.
• Approved for 2 CEUs from AAPC / AHIMA.

 

July 22, 2023, 2:00 PM to 4:00 PM – Master HCC Coding for V28

Registration Link: https://events.eventzilla.net/e/master-hcc-coding-for-v28-2138590697

Agenda:

• Discuss the Rules of the Road for Risk Adjustment.
• Review the Most Common HCCs per MedPac.
• Master Documentation and Coding for HCCs in V28.
• Approved for 2 CEUs from AAPC / AHIMA.

 

August 26, 2023, 2:00 PM to 4:00 PM – V28 Risk Adjustment Optimization

Registration Link: https://events.eventzilla.net/e/v28-risk-adjustment-optimization-2138590696

Agenda:

• Calculate Risk Scores and Payments for V28.
• Identify Potential Areas of Impact in 2024.
• Steps to Optimize Risk Adjustment Operations.
• Approved for 2 CEUs from AAPC / AHIMA.

 

Learn more www.ermconsultinginc.com

Coding from the Problem List or Past Medical History

Over the last few weeks I have received so many emails from coders with this question, “Is it okay for my team to code for conditions listed in the problem list or past medical history only? If not, why? Can you send me a guideline?”

The answer is NO – Your team should NEVER code for conditions that are listed in the problem list or past medical history only. Why? Per ICD-10 Coding Guidelines, codes should only be assigned for documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment, or management.

Coding professionals should not assign codes based solely on diagnoses noted in the history, problem list and/or a medication list. It is the provider’s responsibility to document that the chronic condition affected care and management of the patient for that encounter.

If the medical record is unclear or ambiguous regarding which condition(s) affected patient care and /or management of the patient, query the provider for clarification.

There is overwhelming evidence to support this practice.  

Download / view additional here https://erm365.org/coding-from-the-pl-or-pmh-only/

Advanced Risk Management and HCC Workshop

Are you looking for the best risk adjustment education available? If so, GREAT NEWS, you found it! Join us virtually for a day of risk adjustment, CDI and HCC coding! NEW DATES added below:

June 25, 2021 – Register for tickets here https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808989

July 30, 2021 – Register for tickets here https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808991

August 27, 2021 – Register for tickets here https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808990

September 24, 2021 – Register for tickets here https://events.eventzilla.net/e/advanced-risk-management-and-hcc-workshop--online-2138808986

APROVED by:  AMA, AAFP, AAPC and CCMC - Earn 7.0 CEUs, 6 CMEs and/or 5.5 CEs. - $49 per Attendee

Register your team today and save 10% with group discounts!

LEARN MORE at www.ERM365.org/events
  

Let's Talk About Risk

 Approved by the AAPC for 2 CEUs  - $5.99 (on SALE until 3/25/2021 - then $14.99)

Review the Agenda:

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?

 

Who Should Attend? 

• Coders, Billers, and Auditors
• Physicians, NPs and PAs
• Medical Assistants and Front Office

 

Price: $5.99 SALE until 3/25/2021, then $14.99 

• Purchase includes a copy of the presentation and other resources. 
• 180 days of access to course and materials. 

 

On Demand Course Instructions for CEUs:

1. Login or Register for a FREE account with ERM365.
2. Purchase the course.
3. Click on “My Dashboard” and then “My Courses” to access.
4. Download the handouts and other resources.
5. Watch the video.
6. Pass the post quiz.
7. Download CEU Certificate. 

2021 CMS-HCC Coding Books and Tools

 

Is Your Team Risk Ready?

Arm Your Team For Combat This Risk Adjustment Season!

Prepare for Victory...

What will define those who claim victory and those who are defeated in the battle towards value based care? Will it be those organizations with the most money, power and seats at the table? Or will it be those who are nimble, flexible and open to change?

I believe it will be both. As victory will not be defined by the owners and head coaches but instead by how the players execute on the field. It will be the game time decisions that matter most. A quarterback who can read the defense and adjust accordingly will provide far greater value to the offense than the most athletic quarterback who misses the blitz every time.

Perhaps Napoleon said it best, "Battles are won by the power of the mind." For in a game of inches, the winners and losers will be defined by those who can execute in the moments that matter most. Prepare your team for victory with information at the point of care!

Learn more / order here - https://erm.ecwid.com/

Looking for an MRA Coding Tool?

2021 CMS-HCC Coding Tool Example

We have received several requests from physicians, coders and administrators for an “MRA Cheat Sheet”.

Many have asked for something that is a single page or similar in format to a “charge slip”. 

So, I wanted to share a simple example of one that could be used for primary care providers. 

View or download below. 

Visit www.ERM365.org for more risk adjustment tools and information!

Medicare Risk Adjustment Operations

 

APPROVED by the AAPC for 5 CEUs

Course Overview

Medicare Advantage (MA) is one of the fastest-growing and most complex health plan lines of business representing significant growth opportunities for payers. Launching and/or managing a successful MA market requires careful, strategic planning to meet requirements, ensure compliance, and maximize the program benefits for your organization.

Success in this market will depend on success in each of the following essential areas:

• Value-based contracting
• Clinical documentation and coding
• Delivering high quality care
• Managing utilization

This course will touch on all four essential areas of MRA Operations.

Learn more or Register here

Review the Agenda below:

Risk Adjustment Operations

• Medicare Risk Adjustment Overview
• History of Medicare Risk Adjustment
• Key Concepts and Terms
• Risk Adjustment Data
• Risk Adjustment Process
• Risk Adjustment Data Validation

CMS-HCC Risk Models

• PY 2020 CMS HCC Risk Adjustment Model
• PY 2021 CMS HCC Risk Adjustment Model
• PY 2022 CMS HCC Risk Adjustment Model

Calculating Risk Scores and Payments

• General Payment Rules
• Data Submissions and Payments
• PY 2020 Risk Score Calculations
• PY 2020 CMS-HCC Payment Calculation Example
• PY 2021 Risk Score Calculations
• PY 2021 CMS-HCC Payment Calculation Example

Optimizing RA Operations

• Network Adequacy Guidance
• Medicare Star Ratings
• Growth and Retention
• Reports and Resources

Visit www.ERM365.org to see more courses. 

Let’s Talk About Risk On-Demand

 

Let’s Talk About Risk On-Demand

Join us on-demand for this event recorded 11/11/2020. The presentation is an introduction to risk adjustment and HCC coding for coders, physicians and other healthcare professionals.

Approved by the AAPC for 2 CEUs - only $14.99

https://erm365.org/courses/lets-talk-about-risk-on-demand/

Review the Agenda:

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?

 

Who Should Attend? 

• Coders, Billers, and Auditors
• Physicians, NPs and PAs
• Medical Assistants and Front Office

 

Price: $14.99

• Purchase includes a copy of the presentation and other resources. 
• 180 days of access to course and materials. 

 

On Demand Course Instructions for CEUs:

1. Login or Register for a FREE account with ERM365.
2. Purchase the course.
3. Click on “My Dashboard” and then “My Courses” to access.
4. Download the handouts and other resources.
5. Watch the video.
6. Pass the post quiz.
7. Download CEU Certificate. 

Would you prefer to attend a LIVE event? Visit https://erm365.org/events/ to view the schedule and register. 

Save 30% on all 2020 HCC Tools

 

USE this code: FLASH to save 30% on all HCC Coding Tools!!

Prepare for Victory...

What will define those who claim victory and those who are defeated in the battle towards value based care? Will it be those organizations with the most money, power and seats at the table? Or will it be those who are nimble, flexible and open to change?

I believe it will be both. As victory will not be defined by the owners and head coaches but instead by how the players execute on the field. It will be the game time decisions that matter most. A quarterback who can read the defense and adjust accordingly will provide far greater value to the offense than the most athletic quarterback who misses the blitz every time.

Perhaps Napoleon said it best, "Battles are won by the power of the mind." For in a game of inches, the winners and losers will be defined by those who can execute in the moments that matter most. 

Prepare your team for victory with information at the point of care!

Visit the store to take advantage of the FLASH Sale

 - Remember to use the code "FLASH" to save 30%

Do you like FREE stuff? Register now  so you don't miss out. 

Read the latest post: 6 Reasons Your Risk are Inaccurate

Download the 2021 ICD-10 Updates 

Download the 2021 CMS-HCC Mappings and Software

Learn and earn FREE CEUs from the AAPC

ERM Consulting has developed the industries best training for players on the frontline. Approved by AMA, AAFP and AAPC.

CMS-HCC to ICD-10 Mappings for 2021

CMS has released the initial ICD-10 Mappings and Software for 2021. 

 – The V24 (HCC) Model includes 9,757 ICD-10 Codes 

 – The V05 (RxHCC) Model includes 4,381 ICD-10 Codes

Click on a file below to download.

2021 Initial ICD-10-CM Mappings xlsx

2021 Initial ICD-10-CM Mappings csv

Download the 2021 Initial Model Software from CMS

Visit ERM365 to learn more. 

New Workshop Added in Fort Lauderdale

Join us on Tuesday, May 12th in Fort Lauderdale

Advanced Risk Management - Improve the accuracy of your risk scores!

Are you looking for the best education available in risk adjustment, value-based payments and/or CDI?

Good News - You have found it!

Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE!

Do you need CMEs or CEUs? We have that too!

All Workshops are approved by the American Medical Association, American Academy of Family Practice and the American Academy of Professional Coders.

Register your team ( 3 or more) today to save 10% on any 2020 Workshop!

Take advantage of Early Bird pricing and Save $100!

Overview:

Vast changes are coming to risk adjustment in 2020. What should your team be doing now to prepare? What are the potential impacts to revenue?

Discuss the importance of managing HCCs year over year. What resources are available from CMS to help? 

Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims?

Take a deep dive into HCC Coding and Documentation.

Review NEW HCCs for 2020 and see what documentation is needed to validate payment.

Learn how to leverage frontline staff to be successful in the world of risk adjustment and value-based payments.

Download the Agenda Here

Who Should Attend?

-Providers - MDs, DOs, PAs, and NPs

-Medical Directors - Medicare Advantage, ACOs, CPC+ and Medicaid

-Hospitals and Academic Medical Centers

-Medical Coders, Billers and CDI Specialists

-Executive Leaders, Administrators, Directors and Managers

-MSO and IPA Teams

-Rural Health Centers, FQHCs and Community Health Centers

-Health Alliance Members and Medical Society Members

-Medicare, Medicare Advantage, Medicaid and Commercial Plans

REGISTER BELOW:

Fort Lauderdale on 5/12/2020

Tampa on 3/12/2020

Orlando on 5/9/2020

Each Attendee will Receive ($130):

 - Color copy of the presentation

 - 2020 CMS-HCC Quick Coder

 - Laminated HCC and CDI Tools

 - CME from AAFP and AMA

 - CEU from AAPC

To SPONSOR an EVENT

Please email Kameron Gifford

Early Bird Pricing and Group Discounts

Register NOW to save $100 with Early Bird Pricing!

Bring the WHOLE TEAM!
 Register 3 and save 10% on your order!