Risk Adjustment/Coding Toolkit

Pre-Work Packet: Coding Work Group 2021, Session 5: SelectHealth
Collaborate with your Alliance peers on risk adjustment coding best practices. During each session, you'll review a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

Presentation: Simplify your medical record processing
Join your Alliance peers for a deeper discussion on this hot discussion forum topic.

Baylor Scott & White Health Presentation: Coding Clinic, RADV Audit and CMS/HHS Feedback
Connect with your Alliance risk adjustment peers to discuss your top challenges, share your expertise and build your network.

IU Health Plans Presentation: Show and Tell - Coding Clinic, RADV Audit and CMS/HHS Feedback
Connect with your Alliance risk adjustment peers to discuss your top challenges, share your expertise and build your network.

SelectHealth Presentation: Show and Tell - Coding Clinic, RADV Audit and CMS/HHS Feedback
Connect with your Alliance risk adjustment peers to discuss your top challenges, share your expertise and build your network.

Recording: Show and Tell - Coding Clinic, RADV Audit and CMS/HHS Feedback
Connect with your Alliance risk adjustment peers to discuss your top challenges, share your expertise and build your network.

Article: You’re asking too much of your EHR
MedeAnaltyics shares how true healthcare analytics that pulls data from an EHR can help health plans.

Presentation: Risk Adjustment KPI Dashboards
Dean Ratzlaff, an actuary at Sentara Health Plans (Optima), is back for a deeper dive into the key performance indicator dashboards he and his team use. During our last session, Dean focused on dashboards and data used outside the department (like executives). During this session, Dean and his colleagues share the dashboards they use within the department during and after an intervention campaign and those used for provider engagement.

Recording: Risk Adjustment KPI Dashboards
Dean Ratzlaff, an actuary at Sentara Health Plans (Optima), is back for a deeper dive into the key performance indicator dashboards he and his team use. During our last session, Dean focused on dashboards and data used outside the department (like executives). During this session, Dean and his colleagues share the dashboards they use within the department during and after an intervention campaign and those used for provider engagement.

Recording: Risk Adjustment Roundtable: July 2021
Connect with your Alliance risk adjustment peers to discuss your top challenges, share your expertise and build your network.

Recording: Accreditation - The Pros and Cons of NCQA, URAC, COA
Join your Alliance peers for a deeper dive into this hot discussion forum topic that started May 11, 2021.

Recording: Coding Work Group 2021, Session 3: IU Health Plan
Collaborate with your Alliance peers on risk adjustment coding best practices. During each session, you'll review a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

Pre-Work Packet: Coding Work Group 2021, Session 3: IU Health Plan
Collaborate with your Alliance peers on risk adjustment coding best practices. During each session, you'll review a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.

Recording: Risk Adjustment Roundtable: CON-14 and CON-15 RADV Audit
Hear Alliance member health plans that participated in the CON-14 and CON-15 RADV Audits share their results, status updates and lessons learned. Bring your questions and come prepared to share your health plan’s RADV best practices.

Intervention Tracker
Spreadsheet for risk adjustment intervention tracking. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

Intervention KPIs
Spreadsheet for risk adjustment intervention KPIs. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

Intervention Return
Spreadsheet for risk adjustment intervention ROI. Shared during the May 6, 2021 Risk Adjustment Roundtable: Key Performance Metrics (KPIs).

Recording: Risk Adjustment Roundtable: Key Performance Metrics
Curious what risk adjustment key performance indicators other health plans are using? Alliance members recently shared a number of ideas on the discussion forum. During this call, we’ll go deeper. Dean Ratzlaff, actuary at Sentara Health Plans (Optima), will elaborate on their approach, then we’ll open up the line and the chat for open discussion.

Nested Egg Model of Risk Score Accuracy
Provides a visual aid for explaining that there are several layers to a member's risk score. There is the member's actual medical complexity, what's documented, what's coded and then what's accepted by CMS for aged and disabled, dual eligibles and members with End Stage Renal Disease (ESRD). Drawing by Dean Ratzlaff, Actuary, Sentara Health Plans (Optima) at an Alliance Risk Adjustment at an in-person meeting converted into a PowerPoint slide by the IU Health team.

Recording: Coding Work Group 2021, Session 2: Paramount Health Care
The Paramount Health Care team reviews a collection of recently coded medical charts provided by the health plan host, vote on how you would code each chart, then discuss the results as a group and share best practices. The remaining time is used for open discussion.