Friday, April 2, 2021

Medicare Risk Adjustment Operations


 

Medicare Risk Adjustment Operations

On-Demand 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.

APPROVED by the AAPC for 5 CEUs - $9.99 until 4/9/2021 and then $19.99

Register here https://erm365.org/courses/medicare-risk-adjustment-operations/


Learn more about ERM365


Saturday, March 20, 2021

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. 

Friday, March 19, 2021

Master E/M Coding 2021



E/M Changes Took Effect January 2021


As of January 1, 2021, physicians will select an E/M code based on total time spent on the date of the encounter or medical decision making (MDM)—whichever is most financially advantageous. 


What was the Goal of Revising the E/M Coding for Office Visits?

  • To decrease the administrative burden of documentation and coding
  • To decrease the need for audits, through the addition and expansion of key definitions and guidelines
  • To decrease unnecessary documentation in the medical record that may not be pertinent to the patient’s care
  • To ensure that payment for E/M is resource-based and that there is no direct goal for payment redistribution between specialties

On-Demand Course Agenda


Approved by the AAPC for 3 hours of CEUs - $6.99

Lesson 1 – Introduction

Lesson 2 – 2021 E/M Guidelines and Key Terms
  • Guidelines Common to all E/M Services
  • Services Reported Separately
  • Guidelines for Office or Other Outpatient Services
  • MDM Element Definitions

Lesson 3 – Selecting the Level of E/M Services
  • Instructions
  • New Patient Codes
  • Established Patient Codes

Lesson 4 – Prolonged Services
  • Without Direct Patient Contact
  • Prolonged Clinical Staff Services

Lesson 5 – Frequently Asked Questions


Instructions:
  1. Register for a FREE account on ERM365 (if you do not already have one)
  2. Register for the course 
  3. Complete the lessons
  4. Pass the post test
  5. Print your CEU certificate


View more courses on ERM365


Friday, March 12, 2021

Advanced Risk Management and HCC Coding for Value Based Payments On-Demand

 


Advanced Risk Management and HCC Coding for Value Based Payments On-Demand

Join us on-demand for this event recorded on 11/13/2020. This course is an advanced course on risk adjustment and HCC coding for coders, physicians and other healthcare professionals.

Approved by the AAFP and AMA for 5 CMEs and the AAPC for 7 hours CEUs – only $49.00

https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/


KEY TOPICS INCLUDE:

  • Vast changes are coming to Medicare risk adjustment in 2021 and beyond. Is your team ready? What are the potential impacts to your revenue?
  • Discuss the importance of managing HCCs year over year. What resources are available from CMS to help?
  • What are the components of a risk score and how is it calculated? What is the impact of the payment count?
  • Review NEW HCCs and see what documentation is needed to validate payment.
  • Simple steps for optimizing risk adjustment operations and associated revenue.
  • Take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. See what your team should and should not be coding. 


WHO SHOULD ATTEND?

  • Physicians and Other Providers
  • Coders, CDI Specialists and Auditors
  • Nurses, Medical Assistants and Scribes
  • Medical Directors and CIOs
  • MA, Medicaid and Commercial Plans
  • ACO, MSO and IPA Teams
  • Hospitals and Academic Centers
  • Community Health, RHCs and FQHCs
  • Health Alliance Members

PRICE: $49

On Demand Course Instructions for CEUs:

  1. Purchase the course 
  2. Download the handouts
  3. Watch the video
  4. Pass the post test
  5. Download CEU Certificate
  6. Submit post course survey

Would you prefer to attend a LIVE event? We have several upcoming LIVE events - view the schedule and/or register here https://erm365.org/events/




Wednesday, March 10, 2021

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/



Creating Value in Health Care

 


APPROVED by the AAPC for 4 CEUs - $12.99

On-Demand Course Overview:

We insist on value when we buy our lunch, our car, our clothes, and our home. Why not in healthcare?

Since 2015, the US has been transitioning from a fee-for-service payment system to one based on value. This on-demand course will introduce the concepts of value-based care, population health and social determinants of health with highlights from Dr. Hart’s new book, “Value in Health Care”. By active creation of value in healthcare, we can rein in costs while improving quality outcomes and the experience of patients and providers. 

A journey toward sustainable healthcare with improved results.

“When we identify individual-level social risk factors, we can devise interventions to address them specifically or collect data to understand where community-level interventions might improve a population’s health.”

— Jon Hart, MD MBA


Course Instructions 

  1. Register today and complete at your own pace. 
  2. Complete the course. 
  3. Pass the post test. 
  4. Download your certificate. 


Link to Register

https://erm365.org/courses/creating-value-in-health-care/


View more courses on ERM365


Saturday, February 20, 2021

Opioid Use Disorder

 


Opioid Use Disorder is defined by the DSM-5 as a “problematic pattern of opioid use…”

  • A code of F11.20, opioid dependence, should not be assigned for patients taking pain medication as prescribed.
  • Instead a code of Z79.891, long term use of opiates, should be assigned.

Coders should always be mindful of ICD-10 Guidelines and Coding Clinic Guidance when assigning codes for substance use disorder.

2021 ICD-10 Guidelines (pages 43-44)

Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)

b. Mental and behavioral disorders due to psychoactive substance use

3. Psychoactive Substance Use, Unspecified
As with all other unspecified diagnoses, the codes for unspecified psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9-, F19.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). These codes are to be used only when the psychoactive substance use is associated with a physical disorder included in chapter 5 (such as sexual dysfunction and sleep disorder), or a mental or behavioral disorder, and such a relationship is documented by the provider.

AHA Coding Clinic Guidance

Question:
Medical record documentation indicates the patient is taking opioids prescribed by their physician for treatment of chronic pain. Does Guideline I.C.5.b.3. mean that codes cannot be assigned for the opioid use unless there is documentation of an associated physical, mental or behavioral disorder?

Answer:
A code for the use of prescription opiates would not be reported because there is no associated physical, mental or behavioral disorder.

Reference: AHA Coding Clinic 2018 2nd Quarter, pages 11 and 12

Learn more or download a copy of DSM-5 Criteria here https://erm365.org/opioid-use-disorder/


Saturday, February 13, 2021

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. 





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


Sunday, January 24, 2021

Advanced Risk Adjustment and HCC Coding for Value Based Payments



Due to extremely high demand, new dates have been added for the 2021 workshops!


KEY TOPICS INCLUDE:

Vast changes are coming to Medicare risk adjustment in 2022 and beyond. Is your team ready?

What are the potential impacts to your revenue without RAPS?

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

What are the components of a risk score and how is it calculated? What is the impact of the payment count?

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

Simple steps for optimizing risk adjustment operations and associated revenue.

Take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. See what your team should and should not be coding.


WHO SHOULD ATTEND?

  • Physicians and Other Providers
  • Coders, CDI Specialists and Auditors
  • Nurses, Medical Assistants and Scribes
  • Medical Directors and CIOs
  • MA, Medicaid and Commercial Plans
  • ACO, MSO and IPA Teams
  • Hospitals and Academic Centers
  • Community Health, RHCs and FQHCs
  • Health Alliance Members


EACH ATTENDEE WILL RECEIVE:

  • Color Presentation
  • CME / CEU / CE Certificate (Approved by the AAPC, AMA, AAFP and CCMC)
  • HCC Coding Tools Download
  • 25% off any HCC Tools ordered within 14 days of the event.


HOW DO I REGISTER?

Register here for Friday, February 19, 2021

Register here for Friday, March 26, 2021

Register here for Friday, April 23, 2021

Register here for Friday, May 28, 2021


WHAT IS THE COST?

Tickets - $49  

Bring the Whole Team and SAVE 10% on 3 or more tickets!!


WHERE CAN I LEARN MORE?

Visit ERM365 (www.erm365.org/events) to learn more.

Download the agenda / flyer 






Saturday, January 9, 2021

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. 



Friday, January 8, 2021

MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline Extended to February 1, 2021



For the 2020 performance year, MIPS eligible clinicians, groups, and virtual groups can submit an application to the Centers for Medicare and Medicaid Services (CMS) asking the agency to re-weight one or more performance categories to 0% due to the COVID-19 public health emergency. This means if you have concerns about the impact of the COVID-19 public health emergency on your performance data – including cost measures – you can submit an application to CMS and cite COVID-19 as the reason for your application.

CMS has recently announced that it will be extending the deadline for COVID-19-related 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception applications to February 1, 2021.

If you have concerns about the effect the COVID-19 public health emergency will have on your performance data for the 2020 performance period, including cost measures,  submit an application now and make sure you cite COVID-19 as the reason for your application. The deadline to submit a MIPS Promoting Interoperability Performance Category Hardship Exception application or an Extreme and Uncontrollable Circumstances application not related to COVID-19 remained December 31, 2020. If you are already exempt from reporting Promoting Interoperability data, you don’t need to apply.

Once you have an approved application, you can still receive scores for the Quality, Improvement Activities and Promoting Interoperability performance categories if you submit data. If the Cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted. It is important to note that you cannot submit an application to override data for program year 2020 that has already been submitted and any data submitted either before or after an application has been approved will be scored. 


MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline Extended to February 1, 2021 – Policy & Medicine


Saturday, November 21, 2020

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. 




Advanced Risk Management and HCC Coding ON-DEMAND



 

Advanced Risk Management and HCC Coding for Value Based Payments On-Demand

Join us on-demand for this event recorded on 11/13/2020. This course is an advanced course on risk adjustment and HCC coding for coders, physicians and other healthcare professionals.

Approved by the AAFP and AMA for 5 CMEs and the AAPC for 7 hours CEUs – only $49.00

https://erm365.org/courses/advanced-risk-management-and-hcc-coding-for-vbp-on-demand/


KEY TOPICS INCLUDE:

  • Vast changes are coming to Medicare risk adjustment in 2021 and beyond. Is your team ready? What are the potential impacts to your revenue?
  • Discuss the importance of managing HCCs year over year. What resources are available from CMS to help?
  • What are the components of a risk score and how is it calculated? What is the impact of the payment count?
  • Review NEW HCCs and see what documentation is needed to validate payment.
  • Simple steps for optimizing risk adjustment operations and associated revenue.
  • Take a deep dive into the grey areas and red flags of HCC coding and clinical documentation. See what your team should and should not be coding. 


WHO SHOULD ATTEND?

  • Physicians and Other Providers
  • Coders, CDI Specialists and Auditors
  • Nurses, Medical Assistants and Scribes
  • Medical Directors and CIOs
  • MA, Medicaid and Commercial Plans
  • ACO, MSO and IPA Teams
  • Hospitals and Academic Centers
  • Community Health, RHCs and FQHCs
  • Health Alliance Members

PRICE: $49

On Demand Course Instructions for CEUs:

  1. Purchase the course 
  2. Download the handouts
  3. Watch the video
  4. Pass the post test
  5. Download CEU Certificate
  6. Submit post course survey

Would you prefer to attend a LIVE event? We have several upcoming LIVE events - view the schedule and/or register here https://erm365.org/events/