This program provides a detailed review of foundational and emerging concepts related to HCC coding. Understand the vital role HCCs play in demonstrating patient complexity and assessing the health of populations. Gain familiarity with hierarchical names / numbers in HCC Version 28 and ICD-10 to HCC mappings. Understand how HCCs relate to quality measures and learn about the impact of Artificial Intelligence (AI) on risk adjustment programs.
Realize the importance of following the ICD-10 coding guidelines when selecting diagnosis codes for an encounter and comprehend the essential documentation requirements. The majority of chronic conditions map to an HCC but only when supported by complete, specific documentation.
Highlights:
- Identify specific conditions and assign HCC codes
- Understand how to calculate the RAF score
- Improving documentation to replace unspecified codes
- Explanation of M.E.A.T. criteria
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Jan Hailey
MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
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Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.
Participants will gain knowledge of Hierarchical Condition Category (HCC) coding and risk adjustment in healthcare.
No prerequisites are required.
Self-paced online program includes unlimited review of previously recorded instruction and access to downloadable course materials for 6 months.
Comments from past participants:
"The subject matter is timely and well presented!"
"It gives you the basics of risk adjustment coding which is important today in value based care models."
"Excellent program. Includes good information on documentation guidelines."
Prod ID: 523