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FAQ’s on Online HCC Coding and Risk Adjustment Training


1) What will be the duration of the course?

    The duration of the course is 3 months.

2) How do I sign up?

  • Go to https://www.codingschool.plus/register
  • Fill in your details
  • Once you click on the Register button, you will be redirected to the payment portal.
  • Make your payment.
  • After your payment is approved, you will be given access to the course as well as receive a confirmation email with course login details.

3) What is the cost of the course?

    The cost of the course is $1800 but we offer promotional discounts from time to time. Keep your eye open for these!

4) How do you pay for the course?

    We accept online payments.

5) Can I take a course more than once without paying for it?

    No.

6) What is Blackboard and how do I access it?

    Blackboard is the platform on which our course is designed. You will get access to it once you become a student of Coding School.

7) Are there any downloadable materials in the course?

    No.

8) What if I sign up and I am unable to watch the lectures or take the assignments due to h4 technical problem?

9) Who can register for the course?

    Anyone with a life science or a non-life science background with some knowledge of medical terminology can learn this course. You can also register for the course if you are currently pursuing graduation or post-graduation.

10) Can you tell me more about job opportunities of risk adjustment work?

    Generally, all insurance, especially managed care insurance companies, has opportunities for risk adjustment work. HCC coders are in high demand throughout the year as the volume of work is enormous.

11) What materials and computer specifications are required to complete the course?

    A laptop or a computer with good internet bandwidth is more than sufficient for this course. As part of the registration, we will be providing students with the ICD 10 CM Coding Manual (hard copy).

12) What are Hierarchical Condition Categories or HCCs?

    Risk Adjustment and HCC coding is a payment model that has been mandated by the Centres for Medicare and Medicaid Services (CMS) since 1997. CMS established this payment model as part of the BBA (Balanced Budget Act) for Medicare Advantage plans. These plans
  • – Helps identify individuals who have serious or chronic illness
  • – Assigns a risk factor score to the person based on the individual’s health condition and demographic details.

HCCs are groupings of clinically related ICD 10 CM codes which have similar cost applications. There are about 70000+ ICD 10 CM codes. There are 8830 ICD 10 CM codes which map to the CMS HCC model as per the version 22. These models are based on 25 condition categories which comprises of 79 HCCs.

Not every ICD code carries a value in risk adjustment models, including the Medicare model.

Typically, it is diagnoses that are costly to manage (from a medical management or prescription drug treatment perspective) that are more likely to be found in the risk adjustment models.

13) What is Risk Adjustment?

    Risk adjustment levels all patients being treated within a plan or a group. Levelling refers to categorizing patients according to the seriousness of their conditions or chronic illnesses which may indicate higher medical needs.

14) Why is risk adjustment important?

    Risk Adjustment is important to understand:
  1. current trends in healthcare spending
  2. forecasting future needs of the patients
  3. resources that will be necessary to deliver care more efficiently

15) How do I ensure that a provider’s clinical documentation and coding are as accurate as possible?

    The introduction of risk adjustment led to the increase in the utilization of medical record review and audits. Various types of medical documentation reviews are used to forecast future healthcare needs while explaining current needs and expenses. If one can understand how to perform a documentation review, one can ensure a provider’s clinical documentation and coding are as accurate as possible.

16) What is a risk adjustment factor (RAF)?

    The Risk Adjustment (RA) model utilizes a patient’s demographics and diagnoses to determine the risk score, which is the relative measure of how expensive the patient’s treatment could be. Healthy patients will have a below-average Risk Adjustment Factor (RAF) score. Revenue from their insurance premium is then transferred to the patients who have an above-average RAF score.

17) Which health plans use RAF forms?

    RA programs help insurance companies plan for the future. Here are some reasons to perform a risk adjustment:
    For Medicare Advantage Plans:
  • – Risk Adjustment identifies patients who may need disease management intervention in the future
  • – Risk Adjustment establishes how much the financial allotment for CMS should be for the annual care of each patient
    For Medicaid and Commercial Plans
  • – Risk Adjustment identifies patients who may need disease management intervention in the future
  • – Risk adjustment establishes the “overall state of the population” by aggregating diagnosis; this helps in financial forecasting of future medical requirements.

18) What are some of the important changes to risk adjustment with ICD-10-CM?

    Most conditions that are risk adjusted are chronic and/or life-long illnesses. ICD-10-CM has many new combination codes that may best describe two or more conditions when concurrently present on a date of service. A CMS HCC model change was in place in preparation for ICD-10, and this newer model took cognizance of these combination codes and their respective values. HHS based its model on the CMS model, but it also includes diagnoses that are commonly found in younger individuals. The HHS model does not have a Part D portion, which CMS does, but there are plans to move in this direction on the commercial risk adjustment side.
    The use of ICD-10-CM codes in risk adjustment leads to the documentation of acuity and specificity to be more significant. Here are some examples of increased specificity requirements that are important to include in the documentation for risk adjustment:
  • Hepatitis:
    • Hepatitis, acute hepatitis, unspecified viral hepatitis, alcoholic hepatitis > no HCC
    • Acute hepatitis with hepatic failure > HCC 27
    • Alcoholic cirrhosis > HCC 28
    • Alcoholic hepatic failure without coma > HCC 28
    • Alcoholic hepatic failure with coma > HCC 27
  • Bronchitis:
    • Bronchitis not specified as acute or chronic > no HCC
    • Chronic bronchitis > HCC 111

19) Why do some companies offshore coding in risk adjustment?

    There are some organizations that will not offshore coding work since it is derived from U.S. government-based programs. For organizations that do offshore, the most attractive factor is usually the less expensive coding services.

    Some U.S.-based companies have only offshored their administrative offices. There are a number of coding companies based in other countries that focus on marketing risk adjustment coding services. U.S.-based companies can vary, as well. Some companies specialize in a range of services such as medical record retrieval, analytics, population health management, etc. There are very few companies that specialize only in coding.

20) I've noticed there are other courses. How is yours different from the others available?

    Our curriculum focuses on not just learning the theoretical concepts of the basics of risk adjustment coding such as medicine, anatomy and physiology, complete ICD coding guidelines, etc., but we also provide hands-on practice for the trainees.

    Prospective candidates who go through our curriculum are prepared to face the real world of coding with greater confidence and accuracy.

    Our course is designed completely online and is self-paced. Immediate feedback is provided for the evaluations and is assisted by expert support for clarifications regarding the content.

    Risk adjustment was in full swing for Medicaid and Medicare plans, but the risk adjustment model for the U.S Department of Health & Human Services (HHS) was still being developed.

21) Does the course include ICD10?

    Our course is designed completely in ICD 10 CM.

22) What happens after I register for the program? When can I get started?

    After enrolling, we will provide login details to access our course on the “Blackboard” platform. You will also be provided continuous course learning support through email and through our forum. You can start your preparation to become a HCC coder and can become a HCC coder within one month.

23) Can I access the course content after a course ends?

    Yes, you can access the course content for a period of 90 days.

24) Is placement assured after the course?

    Candidates who perform extraordinarily well throughout the course and are willing to take their career to the next level will be provided with placement assistance.