Risk Adjustment/Coding Toolkit

Reference Material: CROWN collection method mandated by CMS for ESRD
Sentara shares this file as a reference document as part of their workflow: Consolidated Renal Operations in a Web-enabled Network (CROWN) is a Web-based data-collection system mandated by CMS to enable dialysis facilities to meet portions of the Conditions for Coverage for End Stage Renal Disease (ESRD) Dialysis Facilities. Discussed at RA & Quality Micro Summit during ESRD: New challenges and solutions session - February 9, Session 2.

Reference Material: ESRD Workflow_Sentara
Kami Andrews developed the workflow and is Sentara's ESRD contact. Sentara Health Plans shares their ESRD workflow during ESRD session at RA & Quality Micro Summit at ESRD - February 9, Session 2.

Presentation: Health New England Case Study: Improving care through performance improvement projects - February 10, Session 2
Health New England shares how they improve care follow up and health outcomes through performance improvement projects at the RA & Quality Micro Summit - February 10, Session 2.

Presentation: Using Natural Language Processing to enhance risk adjustment and quality outcomes - February 10, Session 1
CDPHP provides actionable takeaways on how to apply NLP in new and impactful ways.

Presentation: Clinical integration challenges during the pandemic - February 9, Session 1
The Network Health team shares its clinical integration challenges and how they've been working to solve them - all while navigating a global pandemic! Shared at the Risk Adjustment & Quality Micro Summit 2021.

Recording: Should We Claim It?
As risk adjustment coders, we often ask ourselves, “Should we claim it?” As part of the Risk Adjustment & Quality Learning Collaborative, Monica Watson reviews common claims billing errors in the provider setting that impact risk adjustment / HCC submissions, best practices for identifying deletes, and more.

Presentation: ESRD: New challenges and solutions_Change Healthcare - February 9, Session 2
Change Healthcare discusses enrolling new members with ESRD, paperwork strategies to ensure revenue is right, home and facility dialysis, and retroactive payments including the completion of CMS-2728 form. Shared at the RA & Quality Micro Summit - February 9, Session 2.

Recording: Clinical integration challenges during the pandemic
The Network Health team shares its clinical integration challenges and how they’ve been working to solve them – all while navigating a global pandemic. Shared at the Risk Adjustment and Quality Micro Summit 2021.

Presentation: Should We Claim It?
As risk adjustment coders, we often ask ourselves, â??Should we claim it?â? As part of the Risk Adjustment & Quality Learning Collaborative, Monica Watson reviews common claims billing errors in the provider setting that impact risk adjustment / HCC submissions, best practices for identifying deletes, and more.

Recording: Risk Adjustment Comparative Overview
As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty provides a comparative look at the different risk adjustment models in the Medicare Advantage, ACA, and Medicaid space.

Agenda: Risk Adjustment & Quality Micro Summit 2021
As part of the Risk Adjustment & Quality Learning Collaborative, Alliance members dig into real-life examples of how they are meeting clinical integration and risk adjustment challenges during the pandemic and share plans for strategic initiatives poised to launch in a post-COVID world.

Presentation: Risk Adjustment Comparative Overview
As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty provides a comparative look at the different risk adjustment models in the Medicare Advantage, ACA, and Medicaid space.

Recording: Documentation and Coding: Best Practices for Chronic Conditions
CMS has instructed that only ‘active’ conditions should be reported via a claim for risk adjustment. As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty with Gorman Health Group discusses what documentation elements are required to substantiate a chronic diagnosis through a Risk Adjustment Data Validation audit.

Presentation: Documentation and Coding: Best Practices for Chronic Conditions
CMS has instructed that only active conditions should be reported via a claim for risk adjustment. As part of the Risk Adjustment & Quality Learning Collaborative, Pat Petty with Gorman Health Group discusses what documentation elements are required to substantiate a chronic diagnosis through a Risk Adjustment Data Validation audit.

Recording: Navigating Risk-Adjustable Chronic Conditions: The Ultimate Course for the PCP
This session is one in a series focused on delivering educational risk adjustment coding content. The topic of this session hasn’t been set yet, but will focus on assisting coders in making appropriate decisions when it comes to coding particularly challenging documentation, provide updates on new diagnostic codes and HCC model updates, or discuss documentation that was accepted or not accepted by CMS.

Presentation: Navigating Risk-Adjustable Chronic Conditions: The Ultimate Course for the PCP
This session is one in a series focused on delivering educational risk adjustment coding content. The topic of this session hasn�t been set yet, but will focus on assisting coders in making appropriate decisions when it comes to coding particularly challenging documentation, provide updates on new diagnostic codes and HCC model updates, or discuss documentation that was accepted or not accepted by CMS.

Acceptable Physician Specialty Types for 2020 PY
CMS provides a comprehensive list of specialists that are approved for risk adjustment for 2020.

Recording: Natural Language Processing: Impact on Coding_Change Healthcare
Change Healthcare explains the impact of the Natural Language Processing (NLP) on code operations, such as code assignment, process, productivity, compliance and financial impact.

Presentation: Natural Language Processing_Change Healthcare
Change Healthcare explains the impact of the Natural Language Processing (NLP) on code operations, such as code assignment, process, productivity, compliance and financial impact.

Recording: Coding Work Group Session 6: MediGold
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.