University of North Florida
Training Programs Medical Certified Risk Adjustment Coder (Voucher Included)
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Certified Risk Adjustment Coder (Voucher Included)

You will learn principles of risk adjustment and accurate diagnosis coding.

Certified Risk Adjustment Coder
$1,495.00 (USD)

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Overview

Objective

Outline

  1. Business of Medicine
    1. Coding as a Profession
    2. The Difference Between Hospital and Provider Services
    3. How a Provider Office Works and How the Coder Fits into It
    4. Understanding the Hierarchy of Providers
    5. The Different Types of Payers
    6. The Medical Record
    7. Operative Report Coding Tips
    8. Medical Necessity
    9. The Advance Beneficiary Notice
    10. The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
    11. The Need for Compliance Rules and Audits
    12. The OIG Work Plan
    13. What AAPC Will Do for You
  2. Medical Terminology and Anatomy Review
    1. Introduction to Medical Terminology
    2. Introduction to Anatomy
    3. Integumentary System
    4. Musculoskeletal System
    5. Cardiovascular System
    6. Lymphatic System
    7. Respiratory System (Pulmonary System)
    8. Digestive System
    9. Urinary System
    10. Reproductive Systems
    11. Nervous System
    12. Organs of Sense—Eye
    13. Organs of Sense—Ear
    14. Endocrine System
    15. Hematologic (Hemic) System
    16. Immune System
  3. Introduction to ICD-10-CM
    1. Overview of ICD-10-CM Layout
    2. Steps to Look Up a Diagnosis Code
    3. ICD-10-CM Official Guidelines for Coding and Reporting
  4. ICD-10-CM Coding Chapters 1–11
    1. Chapter 1: Certain Infectious and Parasitic Diseases (Codes A00–B99)
    2. Chapter 2: Neoplasms (Codes C00–D49)
    3. Chapter 3: Diseases of the Blood and Blood-Forming Organs and Certain
    4. Disorders Involving the Immune Mechanism (D50-D89)
    5. Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89)
    6. Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)
    7. Chapter 6: Diseases of the Nervous System (G00-G99)
    8. Chapter 7: Diseases of the Eye and Adnexa (H00-H59)
    9. Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95)
    10. Chapter 9: Diseases of the Circulatory System (I00-I99)
    11. Chapter 10: Diseases of the Respiratory System (J00-J99)
    12. Chapter 11: Diseases of the Digestive System (K00-K95)
  5. ICD-10-CM Coding Chapters 12–21
    1. Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99)
    2. Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)
    3. Chapter 14: Diseases of Genitourinary System (N00–N99)
    4. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00–O9A)
    5. Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96)
    6. Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00–Q99)
    7. Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00–R99)
    8. Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00–T88)
    9. Chapter 20: External Causes of Morbidity (V00-Y99)
    10. Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00–Z99)
  6. Risk Adjustment Models
    1. Types of Risk Adjustment Models
    2. Medicare Hierarchal Condition Categories (HCC)
    3. The Health and Human Services (HHS) Hierarchical Condition Category Model
    4. Medicaid Chronic Illness and Disability Payment System (CDPS)
    5. Hybrid Model
  7. Predictive Modeling & Quality of Care
    1. CMS Stars Ratings
    2. PQRS (Physician Quality Reporting System)
    3. HEDIS® (The Healthcare Effectiveness Data and Information Set)
  8. How Risk Adjustment Relates to Medical Financial Matters
    1. New Beneficiary Calculations
    2. Annual Risk Adjustment Audits
    3. ACO's (Accountable Care Organizations)
    4. Placing Providers "At-Risk"
  9. Diagnosis Documentation & Coding
    1. Data Collection Sources
    2. Coding for All Diagnoses Noted in a Date of Service (DOS)
    3. ICD-10-CM Updates to the Conventions & Official Coding Guidelines that Affect Risk Adjustment Coding
    4. Coding Diagnoses from the medical documentation
    5. Signature or Credential Issues
  10. Clinical Documentation Barriers
    1. Signs and Symptoms
    2. Uncertain Diagnosis
    3. Coding Clinic Guidance
    4. Risk Adjustment Diagnosis Coding Steps
    5. Acute vs. Chronic
    6. Differential Diagnosis
    7. Risk Factors and Comorbidities
    8. Late Effects
  11. Frequently Coded Conditions in Risk Adjustment Models

Requirements

Prerequisites

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Instructor

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